BIOLOGT 
EJSRAP.r 


MODERN  DIETETICS 


LULU  GRAVES 


MODERN  DIETETICS 


FEEDING  THE  SICK  IN  HOSPITAL  AND  HOME 


WITH 

SOME  STUDIES  ON  FEEDING  WELL  PEOPLE 


BY 
LULU  GRAVES 

DIETITIAN  LAKESIDE  HOSPITAL,  CLEVELAND 


' '  J  ■ »  ' '  1  ' .   '  '     » 


ST.  LOUIS 
THE  MODERN  HOSPITAL  PUBLISHING  COMPANY 

1917 


BIOlOGT 
UBRARY 


Copyright,  1917, 

BY 

The  Modern  Hospital  Publishing  Company 


"Some  ha'e  meat,  and  canna  eat, 
And  some  wad  eat  that  want  it; 
But  we  ha'e  meat,  and  we  can  eat, 
And  sae  the  Lord  be  thankit." 

— Bums. 


364144 


PREFACE. 

With  the  modest  intention  to  help  the  hospitals  of  this 
country  solve  some  of  the  intricate  problems  of  feeding 
the  sick,  The  Modern  Hospital,  a  monthly  journal  de- 
voted to  the  interests  of  hospitals,  sanatoriums,  and 
allied  institutions,  prevailed  on  Miss  Lulu  Graves,  dieti- 
tian of  Lakeside  Hospital,  Cleveland,  Ohio,  to  prepare  a 
series  of  papers  under  the  general  title  of  "Feeding  the 
Hospital,"  dividing  the  topics  so  that  a  paper  could  be 
published  each  month  until  the  series  was  completed. 
There  were  eight  of  these  papers. 

After  the  publication  of  a  few  of  the  papers  it  became 
evident  that  they  were  attracting  more  than  ordinary  in- 
terest. A  number  of  domestic  science  schools  adopted 
them  in  their  curriculums,  teachers  in  some  of  the  better 
medical  schools  used  them  in  their  class  work,  and  more 
than  one  university,  in  the  appropriate  department,  in- 
cluded them  as  part  of  the  work  in  physiology  and  physio- 
logical chemistry. 

So  great  became  the  call  for  copies  of  the  papers  that 
all  back  numbers  of  The  Modern  Hospital  containing 
them  were  soon  exhausted,  and  it  was  then  decided  to 
republish  them  in  volume  form,  making  such  additions 
and  corrections  as  were  necessary  to  have  them  serve  the 
greatest  possible  purpose.  This  monograph,  to  which 
has  been  given  the  title  of  "Modern  Dietetics,"  is  the 
result  of  the  decision  to  publish  these  papers  in  volume 
form. 

Most  fortunately  the  interest  of  Professor  Lafayette 
B.  Mendel  was  attracted,  and,  by  giving  some  of  his 
valuable  time,  he  has  been  good  enough  to  read  the  matter 
critically,  making  such  alterations  as  were  necessary  to 
adjust  some  of  the  scientific  and  controversial  statements. 

vu 


VIII  Preface. 

At  Professor  Mendel's  suggestion  some  pages  have  been 
added  on  the  chemical  constituents  of  the  chief  foods  em- 
ployed in  institutional  feeding,  and  Miss  Graves  has  been 
persuaded  to  append  some  of  the  special  recipes  designed 
by  herself  to  meet  the  requirements  of  the  medical  pro- 
fession in  her  own  hospital. 

It  is  believed  that  the  little  book  will  prove  of  value  to 
physicians,  medical  students,  hospital  administrators, 
dietitians,  and  nurses,  and,  if  this  value  shall  be  realized, 
those  who  have  been  responsible  for  the  publication  of 
the  volume  will  be  abundantly  repaid. 


PREFACE  ADDENDUM. 

Since  the  completion  of  the  material  for  this  book  the 
United  States  has  become  engaged  in  a  war  that  will 
materially  affect  conditions  pertaining  to  the  food  supply. 
It  is  not,  however,  deemed  advisable  to  revise  the  text  of 
the  book  on  that  account,  as  these  conditions  will  change 
from  time  to  time  until  the  situation  again  becomes  nor- 
mal. If  in  the  meantime  a  question  relative  to  this 
changed  state  of  affairs  should  occur  to  the  reader,  the 
author  will  be  pleased  to  discuss  the  matter  either  through 
the  Department  of  Dietetics  in  The  Modern  Hospital  or 
by  personal  correspondence. 

July,  1917. 


CONTENTS. 

^HAPTER  I. 
Managing  the  Institution  Commissary. 
Former  Methods   of  Buying — Necessity  of  Judicious   Buying 
as    to    Quantity,    Quality,   and    Price — Proper    Storage    and 
Care — Scientific  Preparation — Definition   of  a   Good   Cook — 
Methodical  Distribution 4 

CHAPTER  11. 
Food  Value  of  Certain  Products. 
General    Principles    of    Correct    Diet — Definition    of    Food — 
Function  in  the  Body — Composition  and  Utilization — Sources 
of  Food 12 

CHAPTER  III. 

Milk  and  Its  Modifications. 

Complete  Food  for  Children,  but  not  for  Adults — Value  of 
Cream  and  Skimmed  Milk — Effect  of  Pasteurization  and 
Sterilization — Use  of  Eiweissmilch,  Koumiss,  and  Cheese  .     .     20 

CHAPTER   IV. 

Butter — Its  Uses  and  Its  Substitutes. 

Food  Value — Availability  and  Physical  Properties — Process  of 
Renovation — Animal  and  Vegetable  Fats — Oleomargarine 
or  Butterine — Suet  and  Lard — Olive  Oil  and  Cottonseed  Oil     27 

CHAPTER  V. 

Vegetables  in  the  Dietary. 

Physical  and  Physiologic  Properties — Differentiation  of  Raw  and 
Cooked  Vegetables — Chacteristics  of  Potatoes,  Beets,  Carrots, 
Onions,  Cabbage,  Cauliflower,  Artichokes,  Tomatoes,  Aspara- 
gus, Lettuce,  Cress,  Celery,  Chicory,  and  Alligator  Pears  .    .     32 

CHAPTER  VI. 

Cereals,  Legumes,  and  Breakfast  Foods. 

Com,  Oats,  Wheat,  and  Rice  the  Principal  Grains  Used — Tapi- 
oca, Sago,  and  Arrowroot — The  Place  of  Legumes  in  the 
Dietary — Some  of  the  Preparations  and  their  Food  Values   .     37 

IX 


X  Contents. 

CHAPTER  VII. 

Fruits — Cooked,  Raw,  Canned,  and  Dried, 

Apples,  Grapes,  Plums — Cranberries — Prunes,  Figs — Lemons, 
Oranges  —  Pineapples,  Bananas  —  Pears  —  Melons  —  Advan- 
tage of  Canned  Fruits — The  Place  of  Fruits  in  the  Hos- 
pital  Dietary 43 

CHAPTER  VIII. 

Coffee,  Tea,  Cocoa,  and  Chocolate. 

Coffee  and  Tea  have  Practically  no  Nutritive  Value,  and  are 
Merely  Stimulants — Cocoa  and  Chocolate  are  Excellent 
Foods,  but  some  Adulterants  are  Harmful — Cereal  "Cof- 
fees" and  their  Use 48 

CHAPTER  IX. 

Poultry  as  a  Hospital  Food. 

All  Fowls  have  the  same  Food  Values,  though  Geese  and 
Ducks  have  too  much  Fat  for  Impaired  Digestion — Little 
Difference  between  White  and  Dark  Meat — Value  of  Proper 
Cooking 53 

CHAPTER  X. 

Eggs  as  a  Staple  Article  op  Diet. 

Value  Due  to  Large  Amount  of  Nutrition — Mildness  of  Flavor 
Facilitates  their  Use  in  Combination  with  other  Foods — 
Fresh  Eggs — Causes  and  Cure  of  Rancidity — Egg  Dishes     .     56 

CHAPTER  XL 

Meats — Their  Storage  and  Preparation. 

Feeding  Values  and  Relative  Availability  of  Beef,  Veal,  Mut- 
ton, Pork,  Liver,  and  Sweetbreads — Choice  Cuts  and  Meth- 
ods of  Preparation — Curing  Processes  of  Meats — Beef  Juice 
and   Beef   Tea 61 

CHAPTER  Xn. 

Fish  and  Oysters  in  the  Dietary. 

Oysters  are  similar  to  Milk  in  Food  Value — Oily  Fishes  More 
Nutritious  than  Others — Some  Superstitions  Exploded — 
Freshness  of  Great  Importance — How  Flavor  of  Oysters  is 
Affected 67 


Contents.  XI 

CHAPTER  XIII. 
Special  Diets  in  Disease. 
Certain   Diseases  the  Result  of  Faulty  Use  of  Food  by  the 
System — Treatment   Mostly   Dietetic — Special   Diets   Neces- 
sary, but  must  be  used  with  Intelligence — Lists  of  Diets    .     .     69 

CHAPTER  XIV. 

Classes  of  People  to  Be  Fed. 

Surgical  Patients — Maternity  Cases — Private  Patients — Feed- 
ing Interns  and  Nurses — Hospital  Help — Making  Menus — 
Food  Carts  and  Containers — Pantries — Diet  Training  for 
Nurses — The  Commissary 87 

CHAPTER  XV. 

Feeding  Various  Institutions. 

Catering  to  the  Tuberculous — Feeding  the  Children — The  In- 
sane have  their  own  Problem — Buying  for  and  Feeding 
Eleemosynary  Institutions — Feeding  Private  Sanatoriums — 
Help  in  the  Kitchen — Dietetics  of  the  Future 100 

CHAPTER  XVI. 

Training  School  Work  in  Dietetics. 

Preliminary  Lessons — Theoretical  and  Practical  Methods  of 
Instruction — Teaching  of  Basic  Principles — Classification  of 
Subjects  for  Convenient  Teaching — Comparison  of  Theory 
and  Practice 131 

CHAPTER  XVIL 
Special  Diets  and  Principal  Foods. 
Special  Diets  Designed  for  Use  in  the  Hospital  or  the  Home — 
Some  of  the  Principal  Articles  of  Food  for  the  Sick  and  their 
Food   Values   in   Calories 140 

CHAPTER  XVIIL 

Composition  of  Common  Foods. 

Atwater  Tables  Prepared  for  the  United  States  Department  of 
Agriculture — Average  Composition  of  Common  American 
Food  Products 150 


XII  Contents, 

CHAPTER  XIX. 
Some  Selected  Recipes  for  the  Hospital. 
Soups— Fish     and     Poultry— Meats— Vegetables— Eggs— Sal- 
ads— Salad  Dressings — Sauces — Desserts — Breads — Cakes — 
Beverages 155 


MODERN   DIETETICS. 


INTRODUCTIOK 

BY  PROFESSOR  LAFAYETTE  B.   MENDEL,   SHEFFIELD   SCIENTIFIC    SCHOOL, 
YALE  UNIVERSITY,  NEW  HAVEN,  CONN. 

"It  will,  I  think,  be  generally  admitted  that  an  accurate 
acquaintance  with  the  quantity  and  quality  of  food  neces- 
sary to  the  maintenance  of  human  health  and  life,  under 
different  circumstances,  is  a  matter  of  great  interest  to 
everyone ;  but  it  is  more  especially  so  to  statesmen,  magis- 
trates, naval  and  military  officers,  physicians  and  sur- 
geons, governors  of  hospitals  and  other  public  institu- 
tions, and  the  guardians  of  the  poor.  To  them  are 
intrusted  the  care  and  supervision  of  the  inhabitants  of 
prisons,  ships,  garrisons,  armies,  asylums,  hospitals,  and 
poor  houses,  and  on  their  knowledge  or  ignorance  de- 
pends the  health  or  disease — the  life  or  death — of  a  con- 
siderable portion  of  the  community." 

This  quotation  from  the  American  edition  of  Pereira's 
"Treatise  on  Food  and  Diet"  deserves  almost  the  same 
emphasis  today  as  at  the  time  of  its  first  publication  in 
1843.  Recent  decades  have  doubtless  witnessed  impor- 
tant advances  in  the  methods  of  institutional  manage- 
ment. Efficient  hospital  organization  is  becoming  recog- 
nized as  an  essential  factor  in  the  progress  of  practical 
medicine;  the  newest  contributions  of  science  are  being 
drawn  on  to  furnish  novel  helps,  not  only  in  the  adminis- 
tration of  the  modern  hospital,  but  especially  in  their 
application  to  therapy;  mechanical  devices  of  the  latest 
type,  new  remedial  agents,  and  aids  to  diagnosis  are  in- 
stalled as  promptly  as  they  are  introduced  and  sometimes 
before  they  have  been  adequately  investigated.    This  is. 


>'" 


2  Modern  Dietetics. 

however,  as  it  should  be,  for  every  hospital  ought  to  be- 
come, in  a  broad  sense,  a  laboratory  for  testing  the  latest 
suggestions  of  the  inventor  or  the  research  w^orker.  A 
liberal  attitude  in  this  respect  is  in  harmony  M^ith  the 
public  w^elfare  and  the  greatest  good  to  the  institution's 
patients  as  well. 

To  the  student  of  nutrition  it  seems  as  if  one  feature  of 
hospital  service  has  been  unduly  neglected,  so  that  it  lags 
behind  the  progress  in  this  branch  of  physiology.  Die- 
tetics in  the  hospital,  as  in  other  institutions,  has  not  re- 
ceived the  recognition  which  it  deserves  both  as  an  essen- 
tial to  the  management  of  the  patients  and  as  a  scheme  in 
the  field  of  treatment.  For  twenty  years  the  movement 
for  the  popularizing  of  current  knowledge  of  the  elements 
of  nutrition  has  received  widespread  attention  in  the 
United  States.  This  country  need  not  be  ashamed  of  the 
contributions  of  its  own  institutes  and  investigators  in 
this  field  of  science.  Newspapers  and  popular  magazines 
are  promptly  translating  the  findings  of  the  laboratory 
into  the  language  of  the  intelligent  nonprofessional 
reader.  But  the  newer  contributions — the  energy  fac- 
tors, the  calorie  idea,  the  specific  features  of  diet  and  its 
culinary  aspects,  the  relation  of  dietary  components  to 
the  alimentary  responses,  etc. — have  been  slow  in  finding 
their  way  into  the  rigid  routine  of  the  average  American 
hospital. 

The  reason  for  this  underestimation  of  dietetics  and 
dietotherapy  may  be  found,  I  believe,  in  the  neglect  of 
these  subjects  as  a  part  of  the  education  of  students  of 
medicine.  Where  ignorance  prevails,  indifference  is 
likely  to  follow.  The  situation  is  reflected  further  in  the 
inadequate  instruction  of  the  trained  nurse  in  the  science 
of  dietetics  and  the  refinements  of  the  culinary  arts  which 
can  find  an  application  at  the  bedside.  Where  problems 
of  economy  and  cost  must  be  considered  on  a  large  scale, 


Introduction.  3 

it  has  not  been  easy  to  enforce  the  prescription  of  diet  to 
the  individual.  Neither  the  average  physician,  the  nurse, 
nor  the  hospital  superintendent  has  been  educated  up  to 
the  highest  standard. 

There  are  signs  of  the  growth  of  a  progressive  spirit 
more  in  harmony  with  the  advanced  suggestions  of  the 
physiology  and  pathology  of  nutrition.  The  medical  cur- 
riculum will  inevitably  be  forced  to  respond  to  the  de- 
mands of  rational  dietetics ;  and,  furthermore,  the  physi- 
cian is  no  longer  the  sole  arbiter  in  matters  of  diet.  The 
trained  dietitian  has  come  to  stay.  This  monograph  by 
Miss  Lulu  Graves  is  one  of  the  timely  attempts  to  point 
out  the  possibilities  of  progress  and  to  encourage  a  more 
tolerant  attitude  toward  dietotherapy  and  a  rational 
scheme  of  nutrition  applied  in  the  hospital. 


CHAPTER  I. 
MANAGING  THE  INSTITUTION  COMMISSARY. 

FORMER  METHODS  OF  BUYING — NECESSITY  OF  JUDICIOUS 
BUYING  AS  TO  QUANTITY,  QUALITY,  AND  PRICE — PROPER 
STORAGE  AND  CARE — SCIENTIFIC  PREPARATION — DEFINI- 
TION OF  A  GOOD  COOK — METHODICAL  DISTRIBUTION. 

Formerly  it  was  a  common  custom  among  wholesale 
dealers  to  dispose  of  their  less  desirable  products  to  insti- 
tutions. It  was  usually  a  safe  procedure,  as  there  was  no 
one  in  authority  who  took  either  time  or  trouble  to  pass 
judgment  on  the  food  materials  when  delivered,  or  to  see 
that  they  received  the  proper  treatment  after  delivery. 
This  gave  to  the  wholesale  dealer  the  same  opportunity  to 
dispose  of  much  of  his  stock  that  might  otherwise  mean  a 
loss  as  is  given  to  the  retail  dealer  by  the  family  which 
orders  the  day's  supplies  by  telephone  or  sends  a  child 
to  the  store  to  do  the  purchasing.  These  methods  are  no 
longer  prevalent  in  either  homes  or  institutions  conducted 
on  a  business  basis,  with  standards  of  efficiency  and 
economy.  As  every  person,  sick  or  well,  connected  with 
an  institution  in  any  capacity  must  eat,  it  is  a  self-evident 
fact  that  the  commissary  department  is  one  of  the  most 
important,  and  it  must  be  given  the  same  intelligent 
thought  that  is  given  to  any  department  of  the  whole 
organization. 

The  foundation  of  a  well-ordered  commissary  depart- 
ment is  judicious  buying.  Buying  judiciously  means  not 
only  buying  food  materials  of  a  desirable  quality,  and 
which  contain  the  proper  nutritive  values  for  the  needs  of 
the  people  to  be  fed,  at  a  reasonable  price,  but  also  keeping 
qualities  and  storage  facilities  must  be  considered,  as  well 
as  discounts  offered  for  cash  or  prompt  payment  of  bills. 


Managing  the  Institution  Commissary.  5 

As  the  keeping  qualities  depend  so  much  on  the  storage 
facilities,  the  two  cannot  well  be  separated.  In  the  ma- 
jority of  hospitals  and  other  public  institutions  the  store 
room  is  apt  to  be  space  in  the  basement  which  cannot  be 
utilized  for  any  other  purpose,  or  which  remains  after  all 
other  rooms  are  provided.  If  there  happens  to  be  venti- 
lation in  this  room,  well  and  good ;  if  not,  it  will  do  very 
well  for  a  store  room  anyway — is  the  general  decision. 
This  in  itself  is  very  poor  economy.  We  are  all  well  aware 
that  a  dark,  damp  room  is  conducive  to  the  growth  of 
molds  and  other  forms  of  microorganisms  which  may 
cause  the  rapid  deterioration  of  fruits  and  vegetables, 
either  fresh  or  dried,  and  also  that  it  is  very  difficult  to 
keep  such  a  room  free  from  vermin. 

Fruits  and  vegetables  should  be  kept  in  a  room  that  is 
not  only  well  ventilated,  but  through  which  currents  of 
air  of  a  fairly  even  temperature  are  passing.  In  one  of 
the  larger  hospitals  in  the  East  some  attention  has  been 
given  to  finding  the  best  temperatures  for  storage,  the  con- 
clusion having  been  reached  that  most  vegetables  keep 
best  at  a  temperature  of  42°  F.,  but  that  potatoes  are  bet- 
ter kept  at  a  temperature  of  60°  F.  and  sweet  potatoes  at 
70°  F.  If  proper  conditions  are  not  maintained  in  the 
store  room,  fruits  and  vegetables  must  be  closely  watched, 
and  the  overripe  or  defective  be  frequently  sorted  out, 
and  thus  through  much  handling  is  added  one  more  cause 
for  rapid  decay,  not  to  mention  the  extra  labor  involved. 

Cereals  are  very  difficult  to  keep  in  good  condition  in  a 
warm  room  unless  in  sealed  packages,  and  this  makes 
them  considerably  more  expensive.  The  prepared  cereals, 
particularly,  are  apt  to  become  "wormy"  even  in  sealed 
packages,  and  others  may  become  rancid.  Flour  will  keep 
better  in  cloth  than  in  barrels.  Dried  fruits,  too,  may 
become  "wormy"  or  "musty."  In  fact,  there  are  few,  if 
any,  staple  articles  which  are  commonly  kept  in  the  supply 


6  Modern  Dietetics, 

room  which  do  not  keep  better  in  a  clean,  dry,  well-lighted, 
well-ventilated  room,  even  though  they  may  not  actually 
spoil  elsewhere.  Moreover,  we  are  all  inclined,  and  not 
without  reason,  to  associate  a  dark,  damp  room  with  mice, 
roaches,  and  other  vermin,  so  that  naturally  we  dislike  to 
associate  our  food  materials  with  that  kind  of  a  place. 

Besides  temperature,  ventilation,  and  light,  another  im- 
portant feature  of  a  store  room  is  space.  If  the  conditions 
are  favorable  for  keeping  supplies,  it  is  of  great  advantage 
to  be  able  to  buy  in  large  quantities;  particularly  is  this 
true  of  apples,  potatoes,  and  all  vegetables  that  can  be 
bought  for  a  much  lower  price  at  the  time  they  are  being 
gathered  and  stored  for  use  during  winter. 

If  enough  business  is  given  to  them  to  warrant  their 
doing  so,  some  of  the  larger  firms  will  inform  their  buyers 
when  the  probable  lowest  price  for  the  season  on  a  par- 
ticular article  has  been  reached,  or  advise  them  as  to 
when  it  is  a  propitious  time  to  buy.  This  is  known  as 
"protecting"  the  customer.  We  are  all,  however,  apt  to 
make  mistakes  at  times,  and  occasionally  it  happens  that 
the  buyer  is  not  protected,  but  at  any  rate  he  is  on  an 
equal  footing  with  the  merchant,  and  the  odds  are  in  his 
favor  the  greater  number  of  times.  On  the  other  hand, 
giving  orders  to  more  than  one  firm  creates  a  competition, 
and  on  the  whole  is  a  better  plan,  provided  there  be  more 
than  one  firm  available  furnishing  desirable  products. 

The  lowest-priced  article  is  not  always  the  most  eco- 
nomical purchase.  For  example,  there  is  more  economy 
in  buying  select  apples  at  $5.00  per  barrel  than  in  buying 
an  inferior  quality  at  $4.00  or  $4.25,  which  may,  and  prob- 
ably does,  contain  enough  wormy  or  decayed  apples  to 
make  the  price  really  equal  that  of  the  better  grade,  or 
in  which  the  flavor  of  those  that  are  "specked"  may  be  so 
much  less  agreeable  that  they  should  be  classed  as  in- 
ferior. 


Managing  the  Institution  Commissary.  7 

Buying  from  a  jobber  is  like  buying  from  a  bargain 
counter.  If  one  is  sufficiently  familiar  with  the  article  to 
be  sure  of  his  own  judgment,  a  very  good  bargain  may 
often  be  found,  but  promiscuous  buying  from  a  jobber  is 
apt  to  result  in  one  finding  that  in  the  end  the  original 
saving  has  been  counteracted  by  the  loss  in  spoiled  or 
inferior  goods  received  from  time  to  time.  Again,  buying 
in  "job  lots"  is  apt  to  lead  one  into  buying,  at  times,  more 
than  is  really  needed ;  then,  in  trying  to  use  up  the  extra 
quantity,  too  frequent  repetitions  of  that  one  food  leads 
to  dissatisfaction  among  the  people  to  be  fed,  and  often 
to  creating  an  antipathy  for  that  particular  food,  making 
it  difficult  to  use  it  at  a  later  time. 

Even  a  more  unsatisfactory  condition  than  buying 
from  a  jobber  is  to  have  to  buy  from  someone  who  has 
influence  in  the  hospital — a  trustee  or  a  trustee's  relative. 
In  such  a  case,  even  the  best  buyer  is  utterly  helpless, 
and  after  a  few  experiences  will  usually  decide  to  take 
what  is  sent  to  the  hospital  from  the  favored  house,  and 
blindly  0.  K.  the  bills  at  the  end  of  the  month,  with 
a  feeling  that  he  is  bound  and  gagged  and  not  strong 
enough  even  to  struggle. 

In  some  of  the  eastern  markets  the  "unit  system"  is 
used.  For  example,  a  specified  number  of  barrels  of  sugar 
constitute  one  unit,  and  a  certain  percentage  of  discount 
is  given  on  the  unit ;  no  further  discount  is  given,  no  mat- 
ter if  one  buys  ten  times  that  number  of  barrels.  In  these 
markets,  of  course,  there  is  no  advantage  in  buying  more 
than  one  unit  at  a  time,  except  it  might  be  to  save  the 
trouble  of  more  frequent  ordering. 

With  the  limited  facilities  for  storage  in  the  average 
hospital,  however,  frequent  ordering  would  be  much  less 
of  a  difficulty  than  caring  for  the  larger  quantity. 

The  demand  for  fresh  fruits  and  vegetables  in  all 
seasons  of  the  year  makes  it  necessary  for  them  to  be 


8  Modern  Dietetics. 

grown  in  unnatural  conditions,  ripened  artificially,  and 
some  of  them  transported  long  distances.  Most  of  our 
food  material  in  the  cities  is  handled  by  many  different 
people  before  it  reaches  the  consumer.  All  of  these  things 
may  affect  its  condition  or  its  desirability,  more  or  less, 
and  mean  much  to  the  person  who  is  ill  or  has  an  impaired 
appetite  or  digestion.  Unripe  fruits  or  vegetables  have  a 
large  percent  of  starch  in  a  state  which  makes  it  difficult 
of  digestion.  On  the  other  hand,  if  overripe — because 
of  the  sugars  and  moisture  they  contain — they  furnish  a 
good  medium  for  the  growth  of  molds  and  bacteria,  which 
may  form  objectionable  products. 

Meats  may  be  kept  in  very  good  condition  for  a  reason- 
able length  of  time  in  cold  storage,  but,  if  kept  long  at  a 
higher  temperature  when  taken  into  the  retail  market, 
they  deteriorate  very  rapidly.  This  is  especially  true  of 
fish  and  poultry,  and  the  same  can  be  said  of  eggs. 
Though  a  buyer  knows  all  of  these  essential  things  about 
his  institution,  markets,  and  food  materials,  he  is  not  yet 
completely  equipped  until  he  knows  what  can  and  will 
happen  to  these  food  materials  when  cooked  and  served. 
The  very  best  that  the  market  affords  may  be  purchased, 
and  through  improper  cooking  so  much  of  the  flavor  and 
nutritive  value  be  lost  that  it  will  be  served  as  a  tasteless, 
unattractive  dish,  from  which  the  human  body  is  able 
to  assimilate  very  little,  and  which  palls  on  the  appetite 
and  upsets  the  digestion. 

Experience  has  shown  that  many  of  the  people  em- 
ployed in  the  kitchens  of  hospitals  are  inclined  to  give  very 
little  thought  to  this  important  matter  of  using  fresh  or 
green  food  materials  while  still  in  their  best  condition; 
nor  are  many  of  them  trained  to  cook  things  in  such  a  way 
that  the  flavors  are  properly  developed  or  retained,  or 
that  their  greatest  food  value  and  digestibility  are  ob- 
tained. 


Managing  the  Institution  Commissary.  9 

To  digress  just  a  little,  it  may  be  said  that  the  cooks 
are  not  altogether  to  blame  for  this.  In  employing  a  cook, 
the  hospital  will  almost  invariably  ask  for  experience  or 
ability  to  cook,  rather  than  for  knowledge  of  cooking — 
or  perhaps  it  is  better  to  say  neglecting  to  ask  for  the 
knowledge  as  well  as  the  experience.  A  cook  who  has  had 
many  years'  experience  began  his  career  before  food 
values  or  food  composition  were  subjects  for  study,  and 
because  he  has  done  a  thing  for  twenty  years,  and  it  has 
passed  muster,  to  him  it  is  the  proper  way  to  do  it,  and  his 
ability  to  cook  is  proportionate  to  the  quantities  of  these 
things  he  has  prepared  during  the  twenty  years. 

The  larger  hotels  and  restaurants  are  paying  their  cooks 
more  than  are  hospitals  of  corresponding  size,  and  asking 
of  them  chiefly  that  they  serve  food  highly  seasoned — 
usually  at  the  sacrifice  of  natural  flavor — accompanied  by 
rich  sauces  and  elaborately  garnished.  But  in  which  of 
these  hotels  or  restaurants  can  one  get  a  potato  which  is 
well  cooked,  yet  dry  and  mealy,  or  a  "boiled"  e^^  that  is 
evenly  cooked  and  tender,  or  a  vegetable  that  is  not  swim- 
ming in  fat,  or  a  salad  that  is  really  crisp?  It  is  true 
that  this  very  feature  of  hotels  and  restaurants  does  much 
to  furnish  patronage  for  the  hospitals,  but  it  is  the  busi- 
ness of  the  hospital  to  remedy  it  as  far  as  possible. 

What  inducement,  then,  shall  we  offer  in  order  to  make 
it  worth  the  while  of  our  cooks  to  learn  how  food  should 
be  prepared  in  order  to  obtain  the  most  of  its  nutritive 
value  and  at  the  same  time  not  interfere  with  its  digesti- 
bility ?  One  step  is  to  raise  the  status  of  the  profession, 
and  that  would  be  a  long  and  slow  process ;  another  and 
greater  inducement  will  be  to  pay  higher  salary  and 
thereby  get  competent  people.  At  present  it  seems  to  be 
the  part  of  the  trained  dietitian  to  accomplish  what  she 
can  in  the  way  of  proper  preparation  and  serving  of  food 
with,  in  many  instances,  not  only  inconvenient  working 


10  Modern  Dietetics. 

quarters  and  inadequate  help,  but  often  with  an  utter  in- 
difference of  long  standing,  if  not  open  opposition,  not  only 
in  the  kitchen,  but  from  other  departments  as  well. 

In  addition  to  the  problems  of  buying,  storing,  and 
cooking  of  food  materials  comes  the  question  of  properly 
utilizing  or  distributing  them.  If  meat  is  bought  by  the 
carcass,  where  shall  the  more  nourishing  cuts  be  used  and 
where  those  cuts  which  have  more  delicate  flavor  ?  What 
shall  be  done  with  the  cuts  from  parts  of  the  animal  most 
exercised,  consequently  with  harder  muscle,  fiber,  and  con- 
nective tissue,  yet  with  a  good  percent  of  nourishment? 
Fruits  and  vegetables  are  not  always  delivered  in  the  most 
desirable  condition.  What  shall  be  done  with  that  which 
is  overripe  or  too  green  for  the  purpose  planned  ? 

How  are  the  left-overs  to  be  utilized  so  as  to  be  really 
economical?  Often  there  is  a  small  amount  of  meat, 
vegetable,  fruit,  or  pudding  remaining,  though  not  enough 
to  serve  all  who  eat  in  one  dining  room  or  ward.  Shall 
we  have  such  a  routine  established  that  these  cannot  be 
served  to  the  people  for  whom  they  were  originally 
planned?  Or  shall  they  be  eaten  by  the  employees  in  the 
kitchen — perhaps  in  addition  to  their  regular  meal  ?  Shall 
they  be  kept  very  religiously  for  a  few  days  and  then  dis- 
posed of  in  some  wasteful  manner?  A  small  quantity 
of  material  wasted  here,  a  small  amount  not  utilized 
there,  may  in  a  short  time  aggregate  quite  a  large  sum. 
Where  shall  we  make  "good  solid  food"  the  first  thought 
and  economize  on  time,  and  where  shall  we  give  more 
time  to  making  daintiness  and  attractiveness  the  greater 
consideration  ? 

The  tendency  on  the  part  of  the  people  employed  in  our 
kitchens  has  been  to  have  a  set  of  menus  or  dishes  with 
which  they  were  thoroughly  familiar,  and  continue  to  use 
them  indefinitely,  thus  giving  institutional  food  its  pres- 
ent reputation  for  sameness  and  unattractiveness.   People 


Managing  the  Institution  Commissary.  11 

go  into  an  institution  holding  this  prejudice  and  with 
their  minds  made  up  to  be  critical,  and  in  most  hospitals 
they  are  not  disappointed. 

One  who  attempts  to  introduce  variety  into  the  diet  and 
instill  into  the  employees  in  the  kitchen  the  proper  atti- 
tude toward  a  judicious  use  of  all  food  materials,  at  the 
same  time  instilling  into  the  people  being  fed  an  attitude 
of  respect  rather  than  criticism,  has  a  most  prodigious 
task,  one  that  will  require  much  time  and  patience,  but  it 
is  one  worth  while. 


CHAPTER  II. 
FOOD  VALUE  OF  CERTAIN  PRODUCTS. 

GENERAL  PRINCIPLES  OF  CORRECT  DIET — DEFINITION  OF 
FOOD — FUNCTION  IN  THE  BODY — COMPOSITION  AND 
UTILIZATION — SOURCES  OF  FOOD. 

Not  only  does  food  play  a  very  important  part  in 
physical  and  mental  efficiency,  but  it  also  furnishes  one 
of  the  largest  items  in  the  expense  account.  Logically, 
this  would  make  it  one  of  the  first  considerations  in  the 
business  of  living,  but,  as  a  matter  of  fact,  it  is  all  too 
frequently  one  of  the  last,  if  it  is  given  any  consideration 
at  all. 

Nature  has  provided  wisely  for  the  human  body,  not 
only  in  supplying  foods  adapted  to  its  various  needs,  but 
in  providing  facilities  for  utilizing  the  food.  The  ex- 
tent to  which  we  use  or  abuse  this  provision  of  nature 
has  much  to  do  with  the  lasting  qualities  of  the  physical 
mechanism.  Among  those  of  us  who  are  well  and  strong, 
and  wish  to  remain  so,  as  well  as  among  those  who  are 
handicapped  by  physical  weakness,  there  is  a  more  wide- 
spread interest  in  the  quality  and  quantity  of  food.  No 
doubt  this  is  partly  due  to  the  emphasis  many  of  our 
leading  medical  men  are  placing  on  the  dietetic  treatment 
of  disease.  For  the  reason  that  it  is  only  in  recent 
years  that  this  has  been  given  much  attention,  there  are 
comparatively  few  facts  or  even  well-established  theories 
on  its  several  phases,  and  we  find  almost  as  many  opin- 
ions as  we  find  advocates  of  scientific  dietaries.  But  on 
one  phase  all  are  agreed — that  more  attention  should  be 
given  to  the  nourishment  and  care  of  the  body,  keeping 
it  fit  all  the  time,  rather  than  relying  on  drugs  or  other 
means  of  furnishing  temporary  stimulation. 

12 


Food  Value  of  Certain  Products.  13 

So  much  is  being  written  on  the  subject  of  food,  food 
materials,  and  diets  that  one  need  have  no  difficulty  in 
acquiring  information.  The  bulletins  issued  by  the 
United  States  Government  at  Washington,  by  the  state 
experiment  stations,  and  by  the  agricultural  colleges  are 
authentic,  and  may  usually  be  obtained  for  the  asking. 
The  terminology  may,  however,  be  confusing  to  one 
not  familiar  with  the  usage  of  the  different  publications, 
as  it  is  not  uniform.  The  terms  most  frequently  in  use 
are  food,  food  material,  and  food  constituents.  A  gener- 
ally accepted  definition  of  food  is  anything  which,  when 
taken  into  the  body,  is  capable  of  building  or  repairing 
tissue,  or  of  furnishing  material  from  which  energy  may 
be  liberated,  though,  in  order  to  be  a  real  food,  it  must 
be  palatable ;  and,  if  the  best  results  are  to  be  obtained, 
it  must  be  easily  digestible. 

All  foods  contain  carbon,  hydrogen,  and  oxygen;  pro- 
teins contain,  in  addition  to  these,  nitrogen,  sulphur,  and 
sometimes  phosphorus  and  other  elements,  this  being 
their  distinction  from  other  food  principles.  Thus  we 
have  the  classification,  nitrogenous  and  nonnitrogenous 
foods ;  the  nonnitrogenous  include  the  carbohydrates  and 
fats. 

Carbohydrates  include  the  sugars  and  starches,  and,  as 
the  name  implies,  are  made  up  of  carbon,  hydrogen,  and 
oxygen,  the  latter  two  being  in  the  same  proportion  as 
water — two  atoms  of  hydrogen  to  one  of  oxygen  (HoO). 
Carbohydrate,  with  the  exception  of  lactose  and  gly- 
cogen, is  obtained  chiefly  from  vegetables  and  fruits. 
Starch,  the  most  complex  form,  is  found  in  all  green 
plants  and  is  manufactured  by  chlorophyl  and  sunlight 
from  the  carbon  dioxid  in  the  air  and  from  water  in  the 
soil.  The  starch  grain  is  inclosed  within  a  cell  wall  (cel- 
lulose)— often  tough,  as  in  rice  and  other  cereals.  When 
in  this  form  it  should  be  cooked  long  enough  and  at  high 


14  Modern  Dietetics. 

enough  temperature  to  soften  the  intercellular  tissue  and 
reach  the  starch  grain,  making  it  more  easily  digested. 
When  the  starch  grains  are  cooked,  they  swell  and  form  a 
homogeneous  paste;  if  cooked  for  some  time,  starch  is 
more  readily  acted  upon  by  the  digestive  juices  (Bailey). 
The  action  of  dry  heat  on  starch  produces  dextrin.  Fa- 
miliar examples  of  this  are  found  in  the  toasting  of  bread, 
browning  of  flour  for  gravies,  etc.  Many  cereals  are  par- 
tially dextrinized,  and  on  this  ground  the  manufacturers 
claim  for  them  that  they  are  more  easily  digested  than 
others. 

But  the  body  cannot  use  starch  even  in  the  form  men- 
tioned ;  it  must  be  changed  to  dextrose,  or  simple  sugars, 
before  being  available — in  fact,  all  forms  of  carbohydrate 
must  be  changed  to  simple  sugars  before  being  absorbed 
by  the  body.  There  are  many  intermediate  steps  to  this 
process,  which  begins  in  the  mouth,  with  the  action  of 
the  ptyalin  producing  the  first  change,  and  is  ended  in 
the  intestines,  where  it  is  changed  to  its  simplest  form. 
Dextrose  is  found  in  natural  form  in  fruit  and  plant 
juices,  honey,  raisins,  and  sweet  corn  in  comparatively 
large  amounts  and  in  small  amounts  in  many  other  vege- 
tables. In  the  body,  dextrose  is  produced  by  the  action 
of  some  of  the  digestive  juices  upon  the  starch  or  sugar 
eaten.  In  cooking,  a  familiar  illustration  of  the  chang- 
ing of  sucrose  to  invert  sugar  is  given  in  the  addition  of 
lemon  juice  or  cream  of  tartar  to  cane  sugar  when  mak- 
ing icing,  fondants,  etc.,  to  prevent  crystallization. 

While  dextrose  is  more  easily  and  quickly  assimilated, 
it  ferments  readily  and  surfeits  quickly.  Carbohydrates 
furnish  energy,  the  waste  being  eliminated  in  the  form  of 
carbon  dioxid  and  water  through  the  breath,  perspiration, 
and  urine.  Cellulose,  though  a  carbohydrate,  is  of  very 
little  food  value.  Sherman  mentions  some  studies  of  the 
utilization  of  cellulose  which  indicate  that  it  may  have  a 


Food  Value  of  Certain  Products.  15 

very  slight  food  value,  though  not  enough  to  be  considered 
for  practical  purposes.  It  is  an  important  aid  to  diges- 
tion, as  it  furnishes  the  necessary  ''bulk"  for  stimulating 
the  motions  of  the  digestive  tract  and  helps  in  preventing 
constipation.  It  should  not  be  eaten  in  too  large  amounts, 
as  it  may  ferment  in  the  intestines  and  produce  gases, 
which  cause  distention. 

In  fat  the  carbon,  hydrogen,  and  oxygen  are  in  a  dif- 
ferent proportion  from  that  of  carbohydrate.  Fat  has 
more  carbon  and  hydrogen  and  less  oxygen.  Fat  gives 
off  more  heat  during  its  metabolism  than  carbohydrate — 
approximately  two  and  one-quarter  times  as  much. 
These  two  may  be  interchanged  in  the  body  as  they  are 
in  diabetes,  but  not  under  normal  conditions.  Fat  is 
digested  in  the  intestines  and  ordinarily  is  practically  all 
absorbed.  When  fat  is  heated  to  the  "cracking  point," 
it  separates  into  fatty  acids  and  glycerol.  These  fatty 
acids  are  the  substances  in  fried  foods  which  are  irritat- 
ing to  the  digestive  tract.  Olive  oil  has  a  high  cracking 
point;  butter,  a  low.  From  the  standpoint  of  digestion, 
olive  oil  is  a  much  more  desirable  form  of  fat  to  use  for 
cooking  purposes  than  butter,  but  its  expense  bars  it 
from  common  use.  There  are,  however,  on  the  market 
many  forms  of  fat  that  answer  the  purpose  equally  well, 
especially  for  deep  fat  frying  and  sauteing,  the  food 
value  and  digestibility  being  much  the  same,  the  chief 
difference  being  in  the  flavor.  These  are  vegetable  oils, 
and  cottonseed  oil  is  the  principal  ingredient  in  all  of 
them.  When  not  heated  to  the  temperature  at  which 
decomposition  takes  place,  butter  is  a  most  easily 
digested  form  of  fat. 

Fat  is  a  concentrated  form  of  food  which  is  easily  as- 
similated. It  is,  therefore,  desirable  in  cases  of  tubercu- 
losis, as  well  as  in  diabetes.  Frequently  patients  object 
to  taking  much  fat,  and  one  must  resort  to  various  de- 


16  Modern  Dietetics. 

vices  for  combining  it  with  other  food  materials.  The 
most  convenient  way  of  doing  this  is  to  use  a  great  deal 
of  butter  or  oil  on  vegetables,  either  cooked  or  in  salads, 
or  in  salad  dressings  and  sauces  to  be  served  with  meats 
or  vegetables.  Dr.  Langworthy  and  his  coworkers  have 
been  making  some  experiments  in  the  use  of  the  cheaper 
forms  of  fat.  They  have  found  sea  foods  and  also  the 
marine  algae,  such  as  Irish  moss,  to  be  some  of  the  media 
for  serving  lard  and  the  cheaper  oils — such  as  suet,  lard, 
and  oils — in  a  way  that  disguises  the  taste  fairly  well. 
Cream  may  be  used  in  liberal  quantities,  though  it  is  a 
comparatively  expensive  form  of  fat. 

As  mentioned  above,  the  nitrogenous  foods  are  those 
which  contain  nitrogen  and  sulphur  in  addition  to  the 
other  food  elements.  The  common  sources  of  animal  pro- 
tein are  milk,  eggs,  and  meat;  of  vegetable  protein, 
legumes  and  cereals.  Animal  protein  foods  are  concen- 
trated and  quite  thoroughly  digested.  Meat  has  an  agree- 
able flavor;  milk  and  eggs  have  a  mild  flavor,  which 
makes  it  not  only  possible  to  use  them  for  a  long  time 
without  palling  on  the  appetite,  but  they  may  be  success- 
fully combined  with  other  food  materials.  These  foods 
contain,  in  addition  to  the  protein,  inorganic  salts  which 
are  valuable.  On  the  other  hand,  vegetable  foods  contain- 
ing protein  are  bulky,  as  stated,  and  some  of  this  bulk  is 
desirable  for  the  process  of  digestion.  They  give  variety 
to  the  diet,  and  are  a  much  less  expensive  form  of  pro- 
tein food  material.  Accessory  food  substances,  recently 
termed  "vitamines,"  are  found  in  cereals,  legumes,  and 
in  the  juices  of  meat.  Just  what  these  substances  are  is 
not  known,  though  they  have  the  power  to  stimulate  met- 
abolism, and  seem  necessary  to  certain  functions.  Gela- 
tin is  a  form  of  derived  protein  very  commonly  used. 
Lusk  says :  "Gelatin  is  an  artificial  derivative  of  collagen, 
an  albuminoid  largely  found  in  the  skeletal  structure  of 


Food  Value  of  Certain  Products.  17 

animals.  It  contains  very  nearly  the  same  amount  of 
nitrogen  as  protein,  and  breaks  up  on  chemical  treatment 
into  some  of  the  amino  acids.  In  the  diabetic,  gelatin 
yields  the  same  amount  of  sugar  as  does  protein ;  it  does 
not  build  up  new  tissue,  though  it  may  diminish  tissue 
waste."  It  is  not  our  purpose,  however,  to  discuss  the 
numerous  proteins  found  in  food  materials,  their  chemi- 
cal dissimilarities,  or  their  function  in  the  body,  except 
in  a  general  way  and  in  connection  with  the  food  in 
which  they  are  found. 

In  cooking,  proteins  are  coagulated  by  heat  and  tough- 
ened by  a  high  temperature.  For  this  reason  meat,  eggs, 
and  milk  should  be  cooked  at  a  temperature  below  the 
boiling  point.  Recent  experiments  would  seem  to  indi- 
cate that  some  of  the  "vitamines"  are  destroyed  at  higher 
temperatures.  Proteins  play  an  important  part  in  the 
chemistry  of  nutrition,  and  are  acted  upon  by  pepsin  in 
the  gastric  juice,  being  changed  to  proteoses  and  pep- 
tones. The  pancreatic  and  intestinal  juices  change  most 
of  them  still  further,  and  they  are  absorbed  by  the  body 
in  the  form  of  amino  acids.  Their  function  is  to  build 
tissue  chiefly,  though  they  may  also  furnish  energy;  the 
waste  is  eliminated  in  the  form  of  urea,  sulphates,  and 
phosphates.  The  casein  of  milk  is  coagulated  by  rennin 
prior  to  further  digestion,  and  this  action  will  be  men- 
tioned more  fully  in  the  discussion  of  milk.  The  carbo- 
hydrates, fats,  and  proteins  are  the  food  principles 
obtained  from  organic  food  materials — those  that  are 
chemically  changed  and  oxidized  incidental  to  their  utili- 
zation by  the  body. 

Foods  contain  other  food  principles  of  an  inorganic 
nature,  many  of  which  are  taken  into  the  body  and  assimi- 
lated without  further  change.  These  are  mineral  salts 
and  water.  They  do  not  liberate  heat,  nor  do  all  of  them 
build  tissue,  though  many  of  them  help  to  do  this,  and 


18  Modern  Dietetics. 

some  are  essential  for  body  development.  The  mineral 
salts  found  in  the  ordinary  diet  are  sufficient  for  ordi- 
nary use.  If  any  are  lacking,  it  is  most  apt  to  be  iron 
and  calcium.  In  a  vegetable  diet  sodium  chlorid  (common 
salt)  may  be  lacking,  as  vegetables  contain  little  sodium 
salt  in  soluble  form  as  compared  with  animal  food. 
Many  of  the  vegetables  contain  large  amounts  of  alkalies. 
Often  sodium  chlorid  is  added  for  flavor  only.  Sodium 
and  potassium  help  in  the  construction  of  blood  cells  and 
muscles.  Calcium  is  necessary  for  the  growth  of  bone 
and  teeth.  Milk  and  eggs  are  rich  in  calcium,  and  this 
is  one  reason  why  they  are  good  foods  for  children. 

Iron  is  necessary  for  the  production  of  hemoglobin. 
The  amount  of  iron  salts  present  in  vegetables  depends  on 
the  soil  in  which  they  are  grown,  and  the  amount  left  in 
meats  depends  on  the  bleeding  of  the  animal  when  killed. 
Green  vegetables,  especially  spinach,  are  relatively  rich 
in  iron,  and  some  cereals,  beef,  and  egg  yolk  are  other 
sources.  Phosphorus  and  magnesium  are  other  elements 
found  in  the  body  in  large  enough  quantities  to  be  men- 
tioned. Phosphorus  is  furnished  in  the  yolk  of  egg  and 
in  milk.  Under  normal  conditions  the  requirements  of 
the  body  for  mineral  salts  will  be  met  by  the  use  of  a 
mixed  diet. 

Drinking  water  usually  contains  mineral  salts,  and  the 
character  of  those  present  is  indicated  by  the  hardness  of 
the  water.  If  these  salts  are  in  the  form  of  carbonates, 
they  may  be  precipitated  by  boiling  and  the  water  made 
soft;  but  if  they  are  in  the  form  of  sulphates,  it  can  be 
made  "soft"  only  by  the  use  of  chemicals.  So  many  of  the 
processes  of  metabolism  are  due  to  hydrolysis  that  water 
is  necessary  in  keeping  the  body  well  nourished,  even  if  it 
contains  no  nutritive  constituents.  The  average  person 
requires  from  five  to  six  pints  of  water  daily,  depending 
on  his  habits  and  the  temperature  of  the  atmosphere  sur- 


Food  Value  of  Certain  Products.  19 

rounding  him,  though  not  all  of  this  is  furnished  by  actu- 
ally drinking  it.  Considerable  is  present  in  foodstuffs  and 
some  is  produced  from  the  combustion  of  foodstuffs  in 
the  metabolism. 

The  food  value  of  any  material  depends  not  alone  on 
the  percentage  of  food  principles  which  it  contains,  im- 
portant as  they  may  be,  but  also  on  the  amount  of  poten- 
tial energy  it  yields,  its  digestibility,  and  its  availability 
in  the  body.  A  food  may  yield  excellent  results  in  calo- 
ries of  energy,  and  yet  be  of  little  service  to  the  body 
because  it  is  difficult  of  digestion.  Not  the  food  we  eat, 
but  the  food  we  assimilate,  nourishes  us.  The  portion  of 
food  assimilated  by  the  body  may  differ  greatly  under 
different  conditions.  The  body  may  be  able  to  utilize 
more  at  one  time  than  at  another,  and  the  freshness  of 
the  food,  its  appearance,  and  the  manner  in  which  it  is 
cooked  all  have  their  effect. 


CHAPTER  III. 
MILK  AND  ITS  MODIFICATIONS. 

COMPLETE  FOOD  FOR  CHILDREN,  BUT  NOT  FOR  ADULTS — 
VALUE  OF  CREAM  AND  SKIMMED  MILK — EFFECT  OF  PAS- 
TEURIZATION AND  STERILIZATION — USE  OF  EIWEISS- 
MILCH,  KOUMISS,  AND  CHEESE. 

While  milk  may  be  a  perfect  food  for  a  child,  it  is  not 
ideal  for  the  adult,  as  the  needs  of  the  young  are  not  the 
same  as  those  of  an  adult.  The  requirements  of  the 
young  are  more  for  the  growth  of  tissue  and  bone  than 
for  the  storing  of  fat  or  production  of  energy,  and  milk 
contains  enough  protein  and  mineral  salts  to  meet  these 
requirements.  One  quart  of  milk  contains  about  the  same 
amount  of  nutriment  as  12  ounces  of  beef  or  6  ounces  of 
bread.  Milk  contains  all  of  the  food  principles — carbo- 
hydrates in  the  form  of  lactose,  fat  in  the  fonn  of  cream, 
protein  in  the  form  of  casein  and  albumin,  and  mineral 
salts  and  water.  It  is  easily  and  completely  absorbed, 
but,  as  there  is  no  indigestible  residue,  a  prolonged  use  of 
milk  may  lead  to  constipation  or  dyspepsia.  Because  it 
is  deficient  in  iron,  one  constantly  using  milk  alone  may 
become  anemic.  Bread  and  milk,  when  eaten  together, 
make  a  very  good  meal. 

The  composition  of  milk  varies  with  the  different 
breeds  of  cows  and  in  different  cows  of  the  same  breed. 
Jerseys  and  Alderneys  produce  rich,  yellow  milk,  the 
cream  rises  rapidly  and  very  completely,  and  almost  all 
separates  from  the  milk,  leaving  it  thin  and  blue-looking ; 
in  the  milk  from  Holsteins  and  Durhams  the  cream  rises 
slowly  and  not  at  all  completely,  leaving  a  richer  skimmed 
milk.  Cream  contains  all  the  food  principles,  though  they 
are  in  very  small  amounts  except  fat.     The  particles  of 

20 


Milk  and  Its  Modifications.  21 

fat  in  cream  are  very  finely  divided,  making  it  easy  of 
digestion.  Cream  does  not  produce  as  much  energy  as 
butter,  and  it  is  a  proportionately  more  expensive  food. 
The  use  of  cream  as  an  accessory  to  so  many  of  our 
present-day  dishes  is  due  to  a  habit,  or  a  cultivated  taste 
for  rich  things,  rather  than  to  a  logical  combination  of 
materials. 

Skimmed  milk,  or  separator  milk,  contains  the  nitroge- 
nous food  principles,  mineral  salts,  and  sugar,  but  lacks 
fat  if  the  separation  has  been  effective.  The  value  of 
skimmed  milk  is  not  generally  appreciated,  and  it  may 
well  be  used  in  cooking  where  fat  is  not  needed  or  is  fur- 
nished in  some  other  form.  The  souring  of  milk  does  not 
usually  affect  its  food  value.  Sour  milk  is  produced  by 
lactic  acid-forming  bacteria,  and,  when  this  acid  is 
formed,  the  casein,  which  is  insoluble  in  an  acid  medium, 
is  precipitated,  which  precipitation  continues  until  such 
a  percentage  of  acid  is  formed  that  the  bacillus  acidi 
lactici  will  no  longer  act — in  other  words,  when  this  de- 
gree of  acidity  is  reached,  the  process  of  souring  ceases. 
Other  organisms  may  be  present  and  produce  other 
changes,  though  the  acid  medium  has  a  tendency  to  check 
the  growth  of  putrefactive  microorganisms.  When  casein 
is  precipitated  by  acid  in  the  form  of  a  curd,  the  change 
is  a  physical  one,  and  the  properties  are  the  same  as  they 
were  in  the  sweet  milk.  If  an  alkali  is  added,  the  curd 
will  be  redissolved,  and  sodium  bicarbonate  (common 
baking  soda)  is  most  often  used  for  this  purpose  in  cook- 
ing ;  but  if  the  casein  is  precipitated  by  rennin,  a  chemical 
change  takes  place,  and  the  properties  are  not  the  same, 
as  a  curd  is  formed  that  cannot  readily  be  redissolved  by 
an  alkali.  Rennin  is  the  milk-coagulating  enzyme  of  the 
stomach,  and  rennin  prepared  from  the  stomach  of  a  calf 
furnishes  the  rennet  or  junket  tablets  on  the  market. 
When  rennin  acts  upon  the  casein,  a  clot  is  formed,  which 


22  Modem  Dietetics. 

shrinks  and  squeezes  out  the  whey  and  forms  a  mass  the 
density  of  which  depends  on  the  amount  of  casein  and 
mineral  salts  present  and  the  acidity  of  the  gastric  juice. 
The  normal,  healthy  digestive  apparatus  is  equal  to  the 
task  of  handling  this  mass,  and  failure  to  do  so  indicates 
faulty  digestion.  This  difficulty  may  be  overcome  by 
adding  to  the  milk  lime  water,  barley  water,  or  even  plain 
water  to  dilute  the  milk  and  lower  the  percentage  of 
casein.  Cracker  or  bread  crumbs  will  separate  the  par- 
ticles of  casein  and  hinder  the  formation  of  a  solid  clot, 
another  reason  why  bread  and  milk  make  a  good  combina- 
tion, and  sipping  the  milk  slowly  will  also  help.  Souring 
of  milk  invariably  takes  place  within  a  few  days  after 
being  drawn  from  the  cow,  the  length  of  time  depending 
on  the  cleanliness  of  the  milk  and  the  temperature  at 
which  it  is  kept.  Preventing  this  action  by  means  of 
preservatives  is  no  longer  prevalent  to  any  great  extent, 
nor  is  the  adulteration  of  milk  with  water  practiced  as 
formerly,  since  so  much  has  been  done  by  individuals  and 
communities  to  improve  the  quality  of  milk  sold. 

If  formaldehyd  is  added  to  the  milk  to  preserve  it, 
there  may  not  be,  as  has  been  claimed,  enough  present  to 
do  any  great  harm  to  the  person  drinking  the  milk,  but 
we  infer  that  a  dealer  who  must  resort  to  this  means  is 
producing  milk  that  is  not  clean  or  is  contaminated  in 
some  respect.  The  formaldehyd  destroys  the  lactic 
acid-forming  bacteria,  but  may  not  inhibit  the  action  of 
some  other  microorganisms  which  may  be  more  harmful. 
Milk  is  a  most  excellent  medium  for  the  growth  of  micro- 
organisms, as  it  furnishes  the  required  food  and  moisture 
for  their  activity.  For  this  reason  milk  should  always  be 
kept  in  clean  vessels  and  at  a  low  temperature ;  it  should 
not  be  exposed  in  a  room,  particularly  if  there  are  many 
people  moving  about  in  the  room,  as  is  likely  to  be  the 
case  in  kitchens  of  institutions;  nor  should  it  be  left 


Milk  and  Its  Modifications.  23 

uncovered.  Milk  will  keep  longer  without  souring  if  it  is 
pasteurized.  Pasteurization  of  milk  consists  in  submit- 
ting it  to  a  temperature  of  140°  to  160°  F.  for  a  period  of 
about  twenty  minutes,  the  temperature  varying  with  dif- 
ferent dairies.  This  destroys  many  of  the  bacteria, 
including  the  lactic  acid-forming,  but  not  all.  Pasteuriza- 
tion may  not  give  us  the  product  which  we  want,  but  it 
is  at  least  safer  than  the  same  milk  would  be  in  a  raw 
state.  If,  however,  it  is  not  properly  cared  for  after  pas- 
teurization, it  may  be  worse  than  if  left  raw,  as  the 
activity  of  the  microorganisms  which  are  not  destroyed 
by  the  temperature  of  pasteurization,  or  which  may  get 
into  it  later,  will  not  be  checked. 

Sterilization,  submitting  milk  to  a  temperature  of  212' 
F.,  kills  practically  all  bacteria,  and  sterilized  milk  keeps 
longer,  provided  there  is  no  further  contamination.  This 
high  temperature  destroys  the  emulsion  of  fat,  and  part 
of  the  calcium  salts  are  made  insoluble,  so  that  the  action 
of  the  rennet  is  interfered  with,  the  taste  is  altered,  and 
the  casein  is  less  easily  digested.  Milk  is  being  produced 
by  some  dairymen  who  certify  that  it  has  been  produced 
under  the  best  possible  hygienic  conditions,  which  means 
that  the  cows  are  healthy  and  clean,  the  bams  sanitary., 
and  the  milkers  and  all  utensils  coming  in  contact  with 
the  milk  kept  free  from  contamination.  Some  of  our  cer- 
tified milk  farms  are  models  of  cleanliness  and  care,  and 
the  milk  contains  comparatively  few  bacteria,  but  the 
milk  is  higher  priced,  and  for  this  reason  is  not  used  ex- 
cept in  special  cases  or  by  the  well-to-do. 

For  infants,  or  others  with  very  weak  digestion,  milk 
may  be  peptonized.  Peptonizing  tablets  are  made  from 
an  extract  of  pancreas  containing  proteolytic  ferment, 
which  acts  upon  the  casein  of  the  milk,  making  it  non- 
coagulable.  This  may  be  done  by  either  the  cold  or  warm 
process,  but  for  mouth  feeding  the  process  should  not  be 


24  Modern  Dietetics. 

allowed  to  continue  long  enough  for  the  milk  to  become 
bitter.  When  the  proper  degree  of  peptonizing  has  been 
reached,  the  milk  should  be  put  on  ice  to  prevent  any  fur- 
ther action. 

"Eiweissmilch"  is  found  to  be  very  beneficial  for  chil- 
dren who  have  certain  types  of  digestive  disturbances, 
particularly  intestinal.  This  milk  is  obtained  by  precipi- 
tating the  curd  from  milk  by  heating  to  a  temperature  of 
about  100°  F.  and  adding  rennin  in  the  proportion  of  2 
tablespoonfuls  to  1  quart  of  milk,  allowing  it  to  stand  fif- 
teen or  twenty  minutes,  or  using  less  rennin  and  allowing 
it  to  stand  longer,  keeping  the  temperature  at  about  100° 
F.  until  the  casein  is  coagulated;  then  it  is  drained  for 
about  an  hour  in  a  sterile  muslin  bag.  To  the  curd  of  1 
quart  of  milk  add  1  pint  of  buttermilk;  press  through  a 
fine  sieve  two  or  three  times  and  beat  vigorously.  As 
it  is  difl^cult  to  get  the  curd  fine  enough  to  stay  in  suspen- 
sion, care  must  be  taken  in  warming  the  milk  for  use. 
This  gives  a  milk  rich  in  protein  and  fat,  but  poor  in 
sugar. 

Koumiss  is  another  preparation  of  milk  that  is  valuable 
in  fevers  or  generally  impaired  digestion.  Koumiss  was 
originally  made  from  the  milk  of  mares  that  ran  wild  on 
the  steppes  of  Russia.  In  this  country  cow's  milk  is 
used,  and  fermentation  is  carried  out  by  kephir  grains. 
Lactic  acid  and  other  fermentation  take  place,  and  the 
product  is  readily  digested.  Koumiss  is  expensive,  but 
it  has  a  large  amount  of  nutritive  constituents  rendered 
easy  of  absorption.  A  so-called  koumiss  is  made  by  fer- 
menting milk  with  yeast,  a  very  desirable  substitute. 

Lactose,  or  milk  sugar — the  carbohydrate  of  milk — is  a 
particularly  good  food  for  infants  and  invalids  because  it 
is  easily  digested.  It  is  not  so  sweet  as  cane  sugar,  and 
consequently  does  not  pall  on  the  appetite  so  quickly.  It 
is  readily  acted  upon  by  microorganisms,  splitting  up  into 


Milk  and  Its  Modifications.  25 

lactic  acids.  This  action  is  highly  desirable  in  some  foods 
— buttermilk,  for  instance — ^but  diarrhea  or  infantile  sum- 
mer troubles  may  occasionally  be  produced.  Lactose  is 
used  in  making  pills  and  tablets,  and  is  frequently  fur- 
nished in  the  food  of  typhoid  patients,  in  baby  foods,  and 
in  many  other  cases  where  there  is  need  to  increase  the 
caloric  value  of  the  food. 

Other  products  of  milk  are  cheese  and  butter.  Cheese 
consists  essentially  of  the  casein  and  fat  of  milk,  though 
the  coagulated  curd  entangles  in  its  meshes  small  portions 
of  albumin,  lactose,  and  mineral  salts.  The  nature  of 
cheese  depends  on  the  richness  of  the  milk,  kind  of  milk, 
and  method  of  manufacturing.  If  pure  whole  milk  is 
used  and  clotted  with  rennet,  almost  all  the  food  value  of 
the  milk,  except  the  lactose,  is  transferred  to  the  cheese. 
This  is  the  case  in  making  Cheddar  cheese ;  or,  as  in  the 
making  of  Stilton,  the  proportion  of  fat  is  made  greater 
by  adding  cream ;  or,  in  other  cases,  the  cream  is  removed 
and  a  low  percent  of  fat  is  left.  This  is  sometimes  done 
in  making  cottage  cheese.  The  flavor  depends  on  the 
varieties  of  bacteria  and  molds  used  during  the  ripening 
process,  each  species  producing  chemical  changes  which 
give  characteristic  flavors.  The  ripening  process  con- 
tinues for  weeks,  and  in  some  cases  for  months,  the  flavor 
slowly  growing  stronger  and  the  cheese  more  palatable 
as  time  progresses.  The  soft  cheeses — Camembert,  Stil- 
ton, cream,  Neufchatel,  etc. — should  be  consumed  soon 
after  manufacture.  Neufchatel  and  cream  cheese  are 
similar  to  cottage  cheese,  and  may  be  eaten  after  one  day 
of  ripening.  Cream  cheese  has  more  fat  than  the  other 
two,  but  none  of  them  is  benefited  by  the  curing  process. 
Camembert  is  a  French  cheese  which  ripens  in  about 
thirty  days,  is  kept  in  a  cool  place,  and  a  mold  develops 
during  curing. 

Edam  is  the  most  famous  of  the  Holland  cheeses.    It 


26  Modem  Dietetics. 

is  made  by  using  a  pure  culture  of  slimy  bacteria.  In 
Holland  it  is  marketed  in  about  a  month,  but  when  we  get 
it  in  this  country  it  may  be  several  months  old.  Roque- 
fort is  made  from  goat's  milk  and  ripened  by  a  green 
mold,  has  a  strongly  marked  flavor,  and  is  very  expensive. 
Parmesan  and  its  variations,  Gruyere  and  Gorgonzola, 
are  also  made  from  goat's  milk.  These  are  the  so-called 
fancy  cheeses,  and  the  high  price  is  paid  for  flavor  rather 
than  for  food  value.  This  is  true  of  many  of  our  foods, 
but  is  particularly  likely  to  be  the  case  with  cheese. 

American  cheese  contains  more  nutriment  than  Parme- 
san and  at  half  the  price.  Stilton  is  about  the  same  food 
value  as  American,  but  twice  as  expensive.  Cheese  eaten 
for  flavor  is  an  expensive  food,  but,  if  eaten  for  food  value 
and  the  proper  varieties  are  chosen,  it  is  a  decidedly  inex- 
pensive form  of  protein.  Well-ripened  cheese  is  not  dif- 
ficult to  digest  for  the  average  healthy,  normal  digestion. 
Because  of  the  large  amount  of  fat,  it  may  distress  deli- 
cate digestive  apparatus  unless  it  is  very  finely  divided, 
which  may  be  done  by  grating,  by  thoroughly  chewing, 
or  by  combining  with  milk  or  bread  crumbs.  Eggs  and 
cheese  make  a  combination  of  protein  and  fat  in  a  rather 
concentrated  form,  and  hence  many  people  have  difl^culty 
in  digesting  Welsh  rarebit,  etc.  Another  reason  for  diffi- 
culty in  digesting  cheese  dishes  is  that,  as  a  rule,  too 
much  is  eaten.  Fatty  acids  are  formed  in  small  amounts 
during  the  process  of  ripening,  and  these  may  prove  irri- 
tating and  produce  disagreeable  effects. 

Cheese  should  enter  much  more  largely  into  the  diet 
of  well  people  in  this  country,  as  it  is  one  of  the  most 
nutritious  and  satisfying  foods  we  have.  Europe,  and  in- 
deed all  the  rest  of  the  world,  appreciates  cheese  more 
than  we,  and  uses  it  as  a  regular  and  routine  food. 


CHAPTER  IV. 
BUTTER— ITS  USES  AND  ITS  SUBSTITUTES. 

FOOD  VALUE — AVAILABILITY  AND  PHYSICAL  PROPERTIES — 
PROCESS  OF  RENOVATION — ANIMAL  AND  VEGETABLE  FATS 
— OLEOMARGARINE  OR  BUTTERINE — SUET  AND  LARD — 
OLIVE  OIL  AND  COTTONSEED  OIL. 

While  cheese  contains  nearly  all  the  nutritive  constitu- 
ents that  may  be  obtained  from  milk,  butter  contains 
practically  only  the  fat.  Most  of  the  laws  or  ordinances 
aimed  to  cover  this  subject  require  that  milk  shall  con- 
tain not  less  than  from  3  to  4  percent  of  fat,  but  this 
varies  according  to  the  breed  of  the  cow,  her  care,  condi- 
tion, age,  etc. 

The  fat  may  be  separated  from  the  milk  by  allowing  it 
to  stand  in  a  cool  place  until  the  cream  rises  to  the  top 
because  of  its  lower  specific  gravity.  It  is  then  skimmed 
off,  or  it  may  be  removed  much  more  completely  by  the 
use  of  a  mechanical  separator.  The  proportion  of  cream 
obtained  depends  on  the  method  of  separating,  and  the 
mechanical  separator  can  be  regulated  to  obtain  any  avail- 
able content  of  fat  desired,  the  average  being  18  to  24 
percent.  A  pint  yields  about  1,400  to  1,500  calories,  and 
is  a  desirable  form  of  fat  to  be  used  in  the  diet  of  the  sick, 
for  it  is  very  easily  digested.  Dr.  Hutchison  says: 
"Good  cream  (45  percent)  contains  as  much  fat  as  a 
similar  quantity  of  most  cod  liver  oil  emulsions  and  is 
usually  much  better  borne." 

Cream,  however,  is  an  expensive  form  of  fat,  and,  when 
used  by  a  healthy  person  with  a  normal  digestion,  is  fre- 
quently taken  either  because  of  a  habit  of  demanding 
cream  with  cereals,  desserts,  etc.,  or  to  gratify  a  craving 
for  rich  food,  rather  than  for  nutritive  value.     It  is  not 

27 


28  Modem  Dietetics. 

an  uncommon  thing  for  people  to  insist  on  cream,  either 
plain  or  whipped,  with  a  dessert  otherwise  as  rich  as 
should  be  eaten  at  the  end  of  a  heavy  meal, 

Devonshire  or  clotted  cream  is  prepared  by  heating 
milk  in  deep  pans  in  such  a  way  that  a  rapid  and  very 
complete  separation  of  fat  is  obtained.  This  form  of 
cream  contains  as  much  as  60  percent  fat  and  not  more 
than  half  as  much  milk  sugar  as  ordinary  cream,  for 
which  reason  it  is  particularly  beneficial  in  the  treatment 
of  diabetes. 

Butter  may  be  obtained  from  either  sweet  or  sour 
cream.  That  from  sour  cream  has  a  flavor,  due  to  growth 
of  organisms  during  the  ripening  of  the  cream,  which  is 
characteristic  of  good  butter.  Naturally,  butter  made 
from  sweet  cream  lacks  this  flavor,  but  is  preferred  by 
many,  especially  people  of  southern  and  central  Europe. 
Butter  without  salt  is  also  liked  by  these  people,  but 
neither  the  sweet  nor  the  unsalted  butter  is  as  yet  very 
commonly  used  in  this  country,  except  by  the  people  who 
have  come  here  from  Europe.  Salt  is  not  ordinarily  used 
in  large  enough  quantities  in  butter  to  act  as  a  preserva- 
tive. The  fact  that  sweet  butter  does  not  keep  as  well 
may  be  partially  accounted  for  by  the  lack  of  bacterial 
action  during  the  ripening  and  souring  process.  Consid- 
erable care  is  necessary  to  produce  butter  with  an  agree- 
able flavor.  Most  of  our  modern  dairies  produce  a  very 
uniform  and  excellent  flavor  by  introducing  pure  cultures 
of  the  right  kind  of  bacteria  and  controlling  the  ripening 
process.  While  the  essential  constituent  of  butter  is  fat, 
it  also  contains  small  quantities  of  milk  sugar,  salt,  and 
casein.  If  butter  is  kept  for  any  length  of  time,  the  casein 
undergoes  fermentation,  certain  acids  are  formed,  and 
the  butter  becomes  rancid.  Thorough  washing  removes 
much  of  these  acids. 

Carelessness  in  handling  cream  or  butter  is  not  infre- 


Butter — Its  Uses  and  Its  Substitutes.  29 

quently  practiced.  In  small  dairies  or  rural  communities, 
where  a  rigid  inspection  is  not  enforced,  this  is  particu- 
larly apt  to  occur.  As  a  result,  a  butter  is  produced 
which  is  too  rancid  to  be  put  on  the  market  until  it  is 
subjected  to  a  process  of  renovation.  For  this  renova- 
tion it  is  melted  and  the  objectionable  odors  removed  by 
blowing  air  through  it,  or  by  other  methods  of  applying 
heat  and  washing  it.  The  clear  fat,  which  is  now  quite 
sweet,  is  drawn  off,  mixed  with  milk  and  churned  again. 
The  result  of  this  is  a  product  which  is  much  improved. 
The  degree  of  renovation  depends  on  the  character  of  the 
stock  from  which  it  was  made,  but  renovated  butter  dif- 
fers somewhat  in  composition  from  true  butter  and  should 
not  be  sold  as  such.  Tubs  of  what  is  claimed  to  be  dairy 
butter  are  often  renovated  butter. 

Butter  fat,  on  decomposition,  yields  fatty  acids  which 
are  soluble  in  water — butyric,  caproic,  and  capric;  and 
others  which  are  not  soluble  in  water,  oleic  being  the 
most  abundant.     Butter  fat  contains  40  percent  of  olein. 

The  fat  of  the  human  body  has  a  large  percent  of  olein. 
Olein  has  a  low  melting  point,  and  is  therefore  easily 
digested  and  absorbed.  Taken  in  connection  with  other 
foods,  butter  is  highly  digestible  and  nutritious.  Cooked 
butter,  on  the  other  hand,  is  more  apt  to  disagree,  owing 
to  the  fatty  acids  liberated  by  heat,  which  are  irritating 
to  the  digestive  tract.  For  an  impaired  digestion  it 
should  be  spread  on  bread,  or  combined  with  some  starchy 
material.  Liquefied  fats  are  sometimes  administered  to 
coat  the  stomach  interior  and  prevent  the  action  of  cor- 
rosive poison.  The  effectiveness  of  this  treatment  is  apt 
to  be  overestimated,  as  the  membrane  is  already  mois- 
tened with  mucus,  and  it  is  difficult  to  ingest  enough  fat 
to  coat  the  stomach  sufficiently. 

Oleomargarine,  or  butterine,  is  a  substitute  for  butter, 
in  which  a  part  or  all  the  butter  fat  has  been  replaced  by 


30  Modern  Dietetics. 

other  animal  fats,  or  a  mixture  of  animal  and  vegetable 
fats.  This  combination  of  fats  has  properties  similar  to 
natural  butter  so  far  as  the  nutritive  value  is  concerned, 
but  in  making  this  substitute  the  manufacturer,  natu- 
rally, must  look  for  fats  and  oils  that  are  cheaper  than 
butter,  and  that  can  be  readily  obtained. 

Suet  and  lard  have  a  higher  percentage  of  stearin  and 
palmitin,  both  of  which  have  a  higher  melting  point  than 
olein.  As  stearin  solidifies  more  quickly  than  the  other 
fats,  it  is  more  easily  removed,  and  the  fats  having  a 
lower  melting  point  are  mixed  with  oils  and  varying  quan- 
tities of  butter  to  give  the  appearance  of  the  natural 
article. 

A  perfectly  wholesome  and  nutritious  oleomargarine 
product  has  been  obtained  which  is  as  easily  and  almost 
as  completely  absorbed  as  butter.  While  the  best  grades 
of  butter  have  a  finer  flavor  and  are  more  easily  assimi- 
lated than  any  substitute  yet  produced,  a  good  grade  of 
oleomargarine  is  more  wholesome  and  palatable  than  a 
poor  grade  of  butter.  It  is  available  for  people  who  can- 
not afford  the  more  expensive  article,  and  it  lacks  the 
two  properties  in  butter  before  mentioned  which  may 
be  detrimental — namely,  the  free  butyric  acid,  which  is 
present  in  butter  that  is  not  fresh  and  which  may  be  irri- 
tating to  the  digestive  tract,  and  excess  of  casein,  which 
may  cause  decomposition.  There  is  no  logical  physio- 
logical reason  for  the  rather  widespread  prejudice  against 
the  butter  substitutes. 

Olive  oil  and  cottonseed  oil  are  largely  olein.  The  pref- 
erence given  to  olive  oil  is  due  to  its  flavor.  It  is  no  more 
nutritious  than  some  other  oils  and  is  much  more  expen- 
sive. Owing  to  the  high  price  of  olive  oil,  it  is  some- 
times adulterated  with  cheaper  oils,  and  20  to  30  percent 
of  adulteration  may  be  used  and  not  be  distinguished. 
In  the  United  States  the  adulterant  is  usually  cotton- 


Butter — Its  Uses  and  Its  Substitutes.  31 

seed  oil,  and  in  Europe  it  is  more  likely  to  be  peanut  or 
sesame  oil. 

Cottonseed  oil  is  used  in  enormous  quantities  in  this 
country,  and  much  of  it  is  utilized  in  food  material  of 
some  sort.  Since  it  will  stand  a  higher  temperature  with- 
out smoking  than  lard  or  butter,  it  is  used  a  great  deal 
for  frying  purposes,  and  it  is  also  used  in  salad  oils.  There 
are  on  the  market  combinations  of  cottonseed  oil  which 
have  been  chemically  treated  to  make  the  "cracking 
point"  higher.  When  the  "cracking  point"  of  a  fat  is 
reached,  it  decomposes  into  fatty  acids  and  glycerol.  A 
substance,  acrolein,  is  formed  which  gives  the  odor  to 
heated  fat,  and  this  substance  may  be  responsible  for  the 
difficulty  experienced  by  some  people  in  digesting  fried 
food,  as  it  irritates  the  digestive  tract. 


CHAPTER  V. 
VEGETABLES  IN  THE  DIETARY. 

PHYSICAL  AND  PHYSIOLOGIC  PROPERTIES — DIFFERENTIA- 
TION OF  RAW  AND  COOKED  VEGETABLES — CHARACTERIS- 
TICS OF  POTATOES,  BEETS,  CARROTS,  ONIONS,  CABBAGE, 
CAULIFLOWER,  ARTICHOKES,  TOMATOES,  ASPARAGUS,  LET- 
TUCE, CRESS,  CELERY,  CHICORY,  AND  ALLIGATOR  PEARS. 

Vegetables,  cereals,  and  fruits  furnish  the  necessary 
carbohydrates.  The  carbohydrate  in  vegetables  and  cere- 
als is  chiefly  starch,  and  in  fruits  it  is  sugar.  These  food 
materials  have  very  little  fat,  but  are  relatively  rich  in 
mineral  salts,  and,  with  the  exception  of  the  cereals,  have 
enough  water  in  their  composition  to  aid  quite  materially 
in  supplying  the  needs  of  the  body  in  that  respect. 

All  of  these  food  materials  are  obtained  from  plants — 
in  "vegetables,"  largely  from  the  root,  stem,  or  leaves; 
in  cereals,  from  the  seeds ;  and  fruits  are  what  the  name 
implies.  These  plants  are  made  up  of  innumerable  cells, 
the  walls  of  which  are  cellulose,  inclosing  the  starch 
grains.  The  older  the  plant,  the  tougher  this  cellulose 
becomes,  and  the  hardness  of  this  cellulose  fiber  is  an 
important  factor  in  the  palatability  and  digestibility  of 
vegetables. 

If  the  vegetable  is  young  and  tender,  it  is  at  its  best 
when  cooked  only  for  a  short  time  and  in  a  small  amount 
of  water.  By  this  method  a  minimum  of  the  salts  is  dis- 
solved out,  the  sogginess  of  overcooked  food  is  avoided, 
and  in  green  vegetables  the  natural  color  is  retained.  If 
the  vegetable  is  older,  it  requires  a  longer  cooking  in  a 
larger  quantity  of  water  in  order  to  break  up  the  inter- 
cellular tissue  and  allow  the  starch  grains  to  be  reached. 
Older  vegetables  are  apt  to  have  lost  some  of  their  origi- 

82 


Vegetables  in  the  Dietary.  33 

nal  water  by  evaporation,  and  it  may  be  regained  by  this 
method  of  cooking. 

The  flavors  also  are  affected  by  the  method  of  cooking. 
Flavors  are  due  to  mineral  salts  and  volatile  substances. 
If  not  properly  cared  for,  these  may  be  dissolved  out  in 
the  water  during  cooking  and  thrown  away,  or  escape  in 
the  vapors.  In  the  case  of  strong-flavored  vegetables, 
such  as  onions,  cabbage,  and  turnips,  this  is  desirable ;  or, 
when  vegetables  have  been  stored  for  some  time,  a  strong 
flavor  may  develop,  which  is  preferred  to  be  lost,  and  this 
loss  may  be  caused  to  a  still  greater  extent  if  the  vessel  in 
which  they  are  cooked  is  left  uncovered.  In  vegetables 
belonging  to  the  cabbage  family  the  strong  flavor  is  due  to 
the  presence  of  sulphur  compounds.  During  the  cooking 
process  disagreeable  odors  are  given  off,  and  for  this  rea- 
son many  people  object  to  cooking  them  in  an  uncovered 
vessel.  If  the  vegetables  are  fresh,  this  may  be  overcome 
by  putting  a  piece  of  charcoal  in  the  water  during  cook- 
ing. On  the  other  hand,  chemical  changes  may  take 
place  when  heat  and  moisture  are  applied  for  cooking,  so 
that  flavors  and  odors  are  developed,  which  is  true  of 
cereals  and  a  few  starchy  vegetables. 

So  much  of  the  palatability  and  digestibility  of  vege- 
tables depends  on  their  freshness  and  the  method  of  cook- 
ing that  a  sweeping  statement  cannot  be  made  to  the 
effect  that  certain  vegetables  are  beneficial  in  certain  dis- 
eases or  conditions  and  harmful  in  others.  A  vegetable 
which  is  crisp  and  tender  and  has  been  recently  brought 
from  the  garden  may  differ  very  materially  in  composi- 
tion from  the  article  which  is  served  after  that  vegetable 
has  passed  through  the  treatment  of  marketing,  transpor- 
tation, and  cooking.  A  vegetable  or  fruit  which  must  be 
shipped  from  its  native  place  before  ripening  may  not  be 
used  in  some  instances  where  a  naturally  ripened  product 
could  well  be   utilized.    This  is  one   of  the  points  in 


34  Modern  Dietetics. 

favor  of  canned  vegetables  and  fruits  if  they  are  properly- 
prepared. 

Green  vegetables  are  much  used  in  a  raw  state  for 
salads  and  relishes,  but  the  starchy  ones  should  be  cooked 
before  being  eaten.  Boiling  or  baking  them  cooks  the 
starch,  and  to  a  small  extent  converts  the  starch  into 
more  soluble  products. 

Starch  is  a  very  stable  substance,  and  vegetables  with 
a  high  percent  of  starch  may  be  kept  in  good  condition 
for  a  long  time,  for  which  reason  they  may  be  had  at  any 
season  of  the  year.  Green  vegetables  are  not  so  valuable 
from  the  standpoint  of  nourishment  as  the  starchy  ones, 
but  they  are  nevertheless  very  valuable  in  the  diet.  They 
contain  an  abundance  of  mineral  salts,  which  are  very 
essential  in  metabolism.  They  furnish  "bulk,"  which  aids 
digestion,  and,  when  fresh,  they  are  appetizing  and  stimu- 
late the  flow  of  the  gastric  and  saliva  secretions.  This  is 
especially  true  of  those  which  have  a  pungent  quality, 
such  as  cress,  mint,  peppers,  etc.,  and  some  of  them  are 
antiscorbutic  in  action.  They  are  easily  digested  and  give 
pleasing  variety  to  the  diet.  Their  food  value  is  enhanced 
by  being  served  with  butter  or  cream  sauce  if  cooked,  and 
by  use  of  salad  dressings  or  oil  if  served  as  a  salad.  The 
potato  is  a  staple  article  of  diet  because  it  is  inexpensive, 
has  fairly  high  nutritive  value,  and  may  be  obtained  in 
almost  all  parts  of  the  country.  If  properly  cooked,  it  is 
easily  digested;  baking  or  boiling  with  the  skin  on  pre- 
vents the  mineral  salts  from  being  dissolved  out.  If 
cooked  with  the  skins  on,  potatoes  should  be  pricked  and 
the  skin  broken  to  allow  the  steam  to  escape  if  they  have 
to  be  kept  for  a  time  or  carried  some  distance  before  serv- 
ing, as  is  apt  to  be  the  case  in  a  hospital.  If  this  is  not 
done,  as  the  potato  cools  the  steam  condenses  around  the 
starch  grain,  making  it  soggy.  Overcooking  or  keeping 
in  a  covered  vessel  after  cooking  will  have  the  same  effect. 


Vegetables  in  the  Dietary.  35 

Potatoes  are  a  bulky  food,  and  should  be  used  judiciously. 
New  potatoes,  like  unripe  fruit,  have  undesirable  sub- 
stances and  should  not  be  eaten  by  children  or  people 
with  impaired  digestion ;  old  potatoes,  particularly  if  they 
are  allowed  to  sprout,  have  some  of  the  starch  changed 
and  become  waxy. 

Beets  and  carrots  are  other  vegetables  with  a  high  per- 
cent of  carbohydrate.  They  contain  sugar  as  well  as 
starch.  When  young,  they  are  much  more  nutritious  and 
readily  digested  than  after  the  cellulose  has  toughened. 
Both  have  a  characteristic  flavor,  and  are  desirable  for 
salads  or  relishes  as  well  as  vegetables.  Adding  vine- 
gar and  other  acid  to  beets  softens  the  fiber.  The  leaves 
of  the  young  beet  are  used  for  greens. 

Onions  and  all  vegetables  belonging  to  the  cabbage 
family  are  wholesome,  but  not  especially  nutritious.  They 
contain  mineral  salts,  some  sugar,  and  much  fiber.  The 
strong  flavor  of  onions  is  due  to  volatile  oils,  much  of 
which  may  be  lost  in  the  cooking.  They  are  utilized  in 
soups,  salads,  etc.,  for  their  distinctive  flavor.  The  Span- 
ish and  Bermuda  onions  have  a  milder  flavor  than  the 
others,  and  consequently  are  better  liked  as  vegetables. 

All  "head"  vegetables — cabbage,  lettuce,  cauliflower, 
artichokes — should  be  well  washed  and  placed  "head 
down"  in  a  pan  of  water  to  which  salt  or  vinegar  has  been 
added,  in  order  to  draw  out  any  insects  which  may  be 
hidden  among  the  leaves.  Thompson,  in  his  "Food  and 
Dietetics,"  says  all  foods  should  be  well  washed,  not  only 
for  the  purpose  of  removing  dirt,  but  because  of  possi- 
bility of  contamination  from  the  water  with  which  they 
may  have  been  irrigated  or  treated  for  pests,  or  from  fer- 
tilizer in  the  soil,  and  because  the  larvae  of  the  tapeworm 
and  roundworm  may  adhere  to  their  surface. 

Tomatoes  are  in  great  favor  as  a  food  material  because 
they  may  be  served  in  so  many  ways,  both  cooked  and 


36  Modern  Dietetics. 

raw — as  soups,  vegetables,  salads,  relishes,  etc. — and  be- 
cause they  contain  organic  acids,  which  make  them  appe- 
tizing. Tomatoes  and  cabbage,  when  not  properly  cooked, 
may  cause  difficulties  of  digestion. 

Asparagus  and  artichokes  are  prized  ior  their  delicate 
flavor.  Like  all  flavor  foods,  their  nutritive  value  is  not 
very  great,  and  therefore,  from  the  standpoint  of  nutri- 
tion, they  are  expensive  food  materials.  The  form  of  car- 
bohydrate in  artichokes  is  inulin,  and,  as  this  is  not 
changed  to  sugar  in  digestion,  they  may  be  given  to  dia- 
betic patients.  Asparagus  contains  a  substance  known  as 
asparagin,  and  also  contains  a  relatively  high  percent  of 
purins,  which  is  excreted  by  the  kidneys  in  the  form  of 
uric  acid,  having  a  slight  diuretic  effect.  Lettuce  and 
cress  are  chiefly  cellulose  and  water,  with  very  small 
amounts  of  protein,  sugar,  acids,  and  salts,  which  give 
them  an  aromatic  flavor.  For  this  reason  they  are  liked 
as  appetizers  and  to  give  variety  as  well  as  bulk  to  the 
diet.  In  this  same  class  may  be  placed  celery  and  chicory, 
which,  when  blanched  so  that  they  are  crisp  and  tender, 
can  be  served  as  relishes.  Celery  seed  has  a  slight  medici- 
nal value,  and  celery  salt  furnishes  a  pleasant  flavor  for 
soups,  sauces,  stuffings,  etc.  The  roots  of  the  chicory  are 
sometimes  substituted  for  coffee,  or  used  as  an  adulterant 
of  that  article. 


CHAPTER  VI. 
CEREALS,  LEGUMES,  AND  BREAKFAST  FOODS. 

CORN,  OATS,  WHEAT,  AND  RICE  THE  PRINCIPAL  GRAINS  USED 
— TAPIOCA,  SAGO,  AND  ARROWROOT — THE  PLACE  OF  LEG- 
UMES IN  THE  DIETARY — SOME  OF  THE  PREPARATIONS 
AND  THEIR  FOOD  VALUES. 

In  cereals  and  legumes  all  of  the  nutritive  constituents 
are  represented,  though  the  fat  is  very  low,  and  mineral 
salts  not  so  abundant  as  in  green  vegetables.  The  pro- 
teins and  carbohydrates  occur  in  large  enough  amounts  to 
make  them  very  valuable  as  food  material.  The  protein 
differs  somewhat  in  different  cereals,  but  the  food  value  is 
much  the  same.  They  have  other  nitrogenous  substances 
known  as  amides,  which  also  vary,  but  are  more  abundant 
in  the  growing  plant  than  in  the  seeds. 

Corn  and  oats  have  slightly  more  fat  than  the  other 
cereals.  Cornmeal  is  rich  in  fat  if  the  germ  is  left  in  the 
meal,  though  it  becomes  rancid  much  more  quickly.  It 
has  less  nitrogen  than  the  other  cereals,  and  the  refined 
product  has  lost  much  of  its  food  value.  In  hominy  the 
hull  is  removed  and  the  germ  remains.  Though  hominy 
is  not  a  popular  cereal,  it  is  valuable  from  the  standpoint 
of  nutrition. 

Both  corn  and  oat  cereals  are  popularly  regarded  as 
"heating"  foods  because  of  the  abundance  of  starch  and 
fat  present.  Oats  are  either  rolled  or  cracked.  The 
manufacturers  claim  that  oats  which  have  been  steam 
cooked  and  crushed  between  rollers  require  less  cooking; 
but  these  claims  regarding  cereals  are  misleading,  as  the 
cereals  have  usually  not  been  sufficiently  cooked.  All 
cereals  require  long  cooking  in  order  to  break  down  the 
intercellular  tissue  of  the  hard  envelope  which  incloses 

37 


38  Modern  Dietetics. 

the  starch  grain  and  makes  the  grain  itself  more  soluble. 
A  cereal  containing  the  whole  grain  requires  more  cook- 
ing than  one  made  from  only  a  minor  part  of  the  grain. 
Much  water  is  absorbed  during  the  cooking  of  cereals, 
which  should  be  a  slow  process;  cooking  overnight  in  a 
fireless  cooker,  or  in  a  steam  kettle  at  a  very  low  pressure, 
is  the  best  way  to  thoroughly  cook  the  cereal  and  develop 
the  flavor. 

Wheat  is  the  most  widely  used  cereal.  It  is  ground 
and  part  of  the  outside  removed  in  making  ground  cereals. 
It  is  rolled  and  the  whole  grain  is  used  in  making  "rolled" 
cereals;  dextrinized,  and  with  malt  or  honey  added,  a 
"prepared"  cereal  is  made  from  it;  ground  and  bolted, 
it  is  made  into  flour  of  various  grades,  according  to  the 
process  of  manufacture,  ranging  from  "patent"  to  gra- 
ham. "Whole  wheat"  flour  is  a  misnomer,  as  the  outer 
covering  is  removed  in  making  this  flour.  There  are 
gluten  flours  on  the  market  for  which  the  claim  is  made 
that  they  have  all  or  nearly  all  of  the  starch  removed,  but 
this  claim  is  not  to  be  relied  on.  After  tests  made  of 
every  brand  of  gluten  flour  obtainable,  it  was  found  that 
none  was  safe  to  give  to  a  diabetic  patient,  and  these 
conclusions  were  confirmed  by  subsequent  tests  made  at 
the  University  of  Chicago. 

Much  of  the  so-called  graham  flour  on  the  market  is  a 
mixture  of  an  inferior  grade  of  flour  and  bran,  though 
there  is  still  some  of  the  real  graham  flour  to  be  had, 
which  is  made  by  grinding  the  whole  kernel  without  bolt- 
ing. Unless  the  mixture  is  labeled  as  such,  the  consumer 
has  no  way  of  distinguishing  the  real  graham  flour  from 
the  imitation,  as  it  can  be  detected  only  by  microscopic 
and  chemical  analysis. 

One  of  the  large  packing  houses  has  succeeded  in  pro- 
ducing an  animal  flour  from  "cracklings."  The  use  of  the 
flour  has  not  been  developed  to  any  extent  as  yet,  but 


Cereals,  Legumes,  and  Breakfast  Foods.  39 

when  mixed  with  wheat  flour  a  very  palatable  bread  has 
been  made.  A  sample  of  this  bread  was  shown  by  W.  B. 
Albright  at  the  American  Meat  Packers'  Convention 
which  was  held  in  Cincinnati  in  October,  1916.  Mr. 
Albright  said  animal  flour  made  from  cracklings  could 
be  readily  used  to  increase  the  nutritive  value  of  many 
varieties  of  food.  It  would  be  easily  absorbed  in  soups  or 
in  bread.  Another  use  to  be  recommended  is  in  pure  pork 
sausage.  This  flour  can  be  easily  produced  with  an  aver- 
age content  of  87  percent  protein  and  6  percent  fat. 

Macaroni,  spaghetti,  and  noodles  are  made  from  the 
harder  varieties  of  wheat.  They  are  rich  in  carbohy- 
drates and  proteins,  and  are  almost  completely  absorbed 
in  the  body.  The  nutritive  value  of  plain  macaroni  is 
just  about  the  same  as  that  of  good  wheat  bread,  provided 
the  moisture  content  is  the  same,  and  it  is  less  of  a  tax 
on  the  alimentary  organs  to  digest  macaroni  than  it  is  to 
digest  the  majority  of  bakery  breads.  Some  factories 
are  putting  out  a  form  of  spaghetti  or  noodles  suitable 
for  use  as  a  cereal.  On  the  whole,  these  are  food  ma- 
terials that  might  well  be  used  much  more  than  they  are 
by  the  American  people.  When  combined  with  cheese, 
bacon,  or  milk,  they  make  a  most  nutritious  and 
economical  food. 

Barley  is  another  cereal  of  great  use  in  certain  diets, 
especially  for  children.  At  the  present  time  barley  is  not 
used  as  much  as  it  should  be,  but  in  children's  hospitals 
and  in  the  children's  departments  of  the  more  progressive 
large  general  hospitals  barley  water,  barley  gruel,  and 
barley  jelly  are  standard  forms.  As  soon  as  the  manu- 
facturers of  commercial  barley  forms  begin  to  study  the 
needs  of  the  medical  profession  and  to  cater  to  those 
needs,  undoubtedly  barley  will  find  far  wider  use  for 
adults,  sick  and  well. 

Rice  is  widely  used  for  people  with  weak  digestion, 


40  Modern  Dietetics. 

though  it  is  not  particularly  easy  of  digestion.  The  cook- 
ing of  it  is  a  most  important  factor  with  regard  to  its 
palatability  and  digestibility.  It  is  very  well  absorbed, 
however,  and  is  so  low  in  fat  that  no  difficulty  occurs 
from  that  source.  Unpolished  rice  is  gaining  in  favor. 
That  from  which  all  of  the  covering  of  the  grain  has  not 
been  removed  has  a  "nutty"  flavor  which  is  pleasing. 
After  cooking,  it  has  a  grayish  color,  and  patients  not 
familiar  with  this  kind  of  rice  have  felt  suspicious  of  it 
because  of  this  color.  Since  its  introduction  at  Lakeside 
Hospital,  Cleveland,  the  unpolished  rice  is  in  greater 
favor  than  the  polished.  Unpolished  rice  can  now  be  had 
in  bulk  at  a  price  which  hospitals  can  afford  to  pay. 

There  are  on  the  market  a  number  of  so-called  "pre- 
pared" breakfast  foods  which  are  palatable  and  nutri- 
tious, but  expensive  as  compared  with  other  kinds.  Their 
manufacturers  claim  for  them  that  they  are  cooked  and 
predigested  by  malt  or  other  preparations,  but,  as  a  mat- 
ter of  fact,  they  do  not  have  enough  malt  to  sufficiently 
digest  them,  nor  is  the  dextrinization  extensive  in  these 
"predigested"  brands.  Even  if  the  digestion  were  com- 
plete, it  would  be  no  advantage  to  the  healthy  individual 
to  have  his  food  digested  outside  of  his  body  and  thus 
deprive  the  digestive  organs  of  the  stimulus  of  the  work. 
Only  a  much  impaired  digestive  tract  could  be  benefited 
by  it. 

Other  carbohydrates  which  are  of  high  food  value, 
easily  digested,  and  well  absorbed  are  tapioca,  sago,  and 
arrowroot.  As  a  rule,  these  are  combined  with  milk,  egg, 
or  fruit  juices,  which  add  to  their  desirability  both  as 
food  and  for  the  flavor. 

Legumes  have  a  higher  percent  of  protein  than  cereals, 
but  they  are  less  completely  digested,  and  the  flavor  is 
not  so  popular  as  a  rule.  As  a  source  of  protein  they 
rank  next  to  meat  and  eggs  in  importance,  and  are  much 


Cereals,  Legumes,  and  Breakfast  Foods.  41 

used  by  vegetarians.  Fresh  green  peas  and  beans  are 
easily  digested,  but  when  old  they  are  difficult  to  digest 
unless  cooked  a  long  time.  Dried  legumes  are  tough, 
and  should  be  soaked  for  several  hours  before  cooking. 
It  is  said  that  legumin  and  certain  mineral  salts  form  an 
insoluble  compound  which  cannot  be  made  soft,  which 
means  that  peas  and  beans  should  not  be  soaked  or  cooked 
in  water  that  is  very  hard ;  this  may  be  overcome  by  add- 
ing sodium  bicarbonate  (plain  baking  soda)  to  the  water. 
If  cooked  with  pork  or  fat  beef,  their  food  value  is  very 
much  increased  and  the  combination  is  more  palatable. 

Kidney  beans  are  more  popular  with  people  who  do 
hard,  physical  labor.  Lima  beans  are  very  wholesome, 
and  are  more  popular  with  those  who  have  less  hardy 
appetites.  Soy  beans  are  used  much  in  the  Orient,  but 
are  not  fully  appreciated  here.  Soy  bean  flour  is  used 
in  this  country  in  preparations  for  infant  feeding  and 
also  to  some  extent  in  foods  for  the  diabetic. 

Another  legume  not  properly  appreciated  is  the  peanut. 
It  has  both  fat  and  protein  in  large  percentage,  an  agree- 
able flavor,  and  may  be  utilized  in  many  ways.  During 
the  roasting  process,  which  is  the  method  of  cooking  pea- 
nuts, the  flavor  is  developed  and  the  starch  cooked,  and 
they  are  an  extremely  well-balanced  food. 

Meal  made  from  peas  and  beans  may  be  had  at  a  mod- 
erate cost,  and  is  very  good  for  thickening  soups,  making 
gruels,  etc.,  though  a  puree  of  vegetables  is  better  for 
cream  soups.  Often  when  the  digestive  organs  are  not 
equal  to  the  task  of  disposing  of  vegetables  and  cereals 
which  are  served  in  the  ordinary  way,  strained  cereals  or 
vegetables  may  be  used. 

Gruels,  purees,  and  cream  soups  are  very  nourishing,  and 
logically  follow  the  milk  and  broth  diet  when  a  patient  is 
able  to  utilize  them  and  the  "building  up"  process  begins. 
Another  advantage  is  the  variety  of  ways  in  which  they 


42  Modern  Dietetics. 

may  be  served,  which  leaves  no  excuse  for  a  monotonous 
diet  when  this  stage  is  reached.  Gruels  prepared  from 
thoroughly  cooked  oatmeal,  served  plain  at  one  time,  with 
cream  at  another,  a  well-beaten  Qgg  at  another,  and  with 
beef  tea  or  beef  juice  at  another,  make  a  goodly  number 
of  changes.  These  may  be  followed  by  rice  or  farina  gruel 
with  the  same  variations,  and  with  fruit  juices  or  sherry 
in  addition.  Prune  juice  is  especially  good  with  these 
gruels.  These,  together  with  broths,  custards,  and  gela- 
tin, give  a  wide  enough  range  to  prevent  frequent  repeti- 
tions, and  can  be  managed  even  in  large  hospitals  if  there 
is  the  proper  cooperation  between  the  medical  men  and 
the  kitchen. 


CHAPTER  VII. 
FRUITS— COOKED,  RAW,  CANNED,  AND  DRIED. 

APPLES,  GRAPES,  PLUMS — CRANBERRIES — PRUNES,  FIGS — 
LEMONS,  ORANGES — PINEAPPLES,  BANANAS — PEARS — 
MELONS — ADVANTAGE  OF  CANNED  FRUITS — THE  PLACE 
OF  FRUITS  IN  THE  HOSPITAL  DIETARY. 

Fruits  are  held  by  some  people  to  be  a  luxury  rather 
than  essential  foods.  To  be  of  dietetic  value  does  not 
necessarily  mean  that  a  food  must  build  tissue  or  fur- 
nish energy.  The  sugars  in  fruit  do  furnish  some  energy, 
but  fruits  perform  other  functions  equally  important. 
They  introduce  into  the  system  salts  and  organic  acids, 
which  may  improve  the  quality  of  the  blood  and  react 
favorably  on  the  secretions;  they  serve  as  laxatives  and 
antiscorbutics;  they  are  refreshing,  stimulate  the  appe- 
tite, and  convey  water  into  the  body ;  they  add  a  pleasing 
variety  to  the  diet — not  to  mention  their  usefulness  as  a 
foundation  for  special  cures  and  fads,  such  as  the  grape 
treatment,  etc.  Commercially,  the  delicious  flavors  of 
fruits  are  produced  by  compounds  known  as  ethers,  in 
combination  with  the  sugars  dissolved  in  water,  and  the 
acids.  There  is  little  starch  in  ripe  fruit.  The  acids  are 
quite  similar  to  each  other,  and  most  of  them  are  organic, 
the  three  most  common  being  citric  in  lemons  and 
oranges,  tartaric  in  grapes,  and  malic  in  apples.  These 
are  typical  acids,  though  most  fruits  have  several  kinds. 
Citric  and  tartaric  acids  are  separated  from  fruit  and 
used  commercially  for  many  purposes.  Cranberries  and 
prunes  contain  benzoic  acid.  Pectin  and  pectose  are  forms 
of  carbohydrate  in  fruits,  and  are  the  properties  which 
cause  the  juice  to  "jelly"  when  boiled  in  the  presence  of 
the  acids  and  sugai-  of  the  juice.     Apples,  grapes,  and 

43 


44  Modern  Dietetics. 

plums  have  a  comparatively  large  percent  of  pectin  and 
pectose,  and  are  consequently  more  easily  made  into  jelly 
than  berries  and  many  other  small  fruits. 

A  judicious  use  of  fruit  in  the  diet  is  very  beneficial, 
the  great  danger  being  in  the  use  of  unripe  or  decayed 
fruit.  Cooked  fruit  is  safer  than  the  uncooked,  espe- 
cially if  overripe  or  not  properly  ripened;  the  starch 
which  may  be  present  in  green  fruit  is  more  easily  assimi- 
lated if  cooked.  In  overripe  fruits  bacterial  action  may 
have  begun  which  will  be  checked  by  cooking.  Chemical 
changes  occur  in  the  presence  of  heat,  which  give  different 
flavors. 

Fresh  fruits  are  well  adapted  to  our  needs  in  summer 
on  account  of  their  low  caloric  content  as  well  as  for  rea- 
sons given  above.  Lemons  and  oranges  are  generally 
available,  and  they  are  agreeable  to  nearly  everyone, 
qualities  which  make  them  most  useful  for  the  sick  room. 
They  may  be  used  to  encourage  the  consumption  of  water 
in  renal  disorders,  or  in  any  condition  where  much  water 
is  required.  Made  into  ices  and  sherbets,  they  are  less 
likely  to  disagi'ee  than  ice  cream,  and  are  very  refreshing 
to  patients  with  high  temperature.  A  slice  of  lemon  in 
the  mouth  will  remove  the  disagreeable  taste  due  to  a 
coated  tongue.  Lemons  and  limes  are  valuable  antiscor- 
butics. Pure  lemon  juice  poured  into  the  nose  may  often 
control  epistaxis.  Figs,  prunes,  apples,  and  berries  have 
enough  sugar  to  make  them  of  high  food  value,  and  their 
seeds,  skins,  and  fiber  make  them  helpful  as  laxatives. 
Pineapple  is  not  only  appetizing  and  refreshing,  but  con- 
tains when  uncooked  an  enzyme  which  aids  in  the  diges- 
tion of  protein.  A  common  proof  of  the  action  of  this 
enzyme  is  found  in  the  rapidity  with  which  it  digests  gela- 
tin, a  proof  that  many  a  cook  has  had  when  trying  to 
prepare  a  gelatin  dessert  with  raw  pineapple.  With  the 
exception  of  oranges  and  lemons,  no  other  fruit  is  so 


Fruits — Cooked,  Raw,  Canned,  and  Dried.  45 

beneficial  in  the  diet  of  the  sick  as  pineapple.  Some  of 
our  eastern  physicians  are  finding  pineapple  juice  very 
effective  in  cases  of  anorexia,  and  it  is  a  rather  unusual 
thing  to  find  a  patient  in  a  hospital  who  will  not  enjoy 
preparations  of  pineapple  if  he  can  enjoy  any  food  at  all. 
Bananas  and  pears  are  much  more  easily  digested  if 
cooked,  particularly  if  baked;  they  are  more  readily 
broken  up  by  the  digestive  juices,  and  flavors  are 
developed  which  change  the  original  taste  very  much. 

Alligator  pears — avacado — are  rapidly  coming  into 
favor,  and  they  deserve  to  become  popular.  They  have 
a  large  percent  of  easily  digested  vegetable  oil,  which 
makes  them  particularly  desirable  for  diabetics.  When 
ripe,  the  flesh  is  of  a  greenish-yellow  color,  and  its  con- 
sistency has  been  well  compared  to  that  of  well-made 
butter. 

Another  fruit  which  is  being  introduced  into  the 
United  States  is  the  roselle.  This  plant  has  been  culti- 
vated in  Australia,  where  the  fruit  is  made  into  jam. 
This  jam  is  an  excellent  substitute  for  cranberry  sauce. 
A  very  good  jelly  may  also  be  made  from  the  plant. 

Mastication  plays  an  important  role  in  the  digestion  of 
fruits.  Bananas,  melons,  grapes,  and  blueberries  are  apt 
to  slip  down  the  throat  whole  or  before  being  finely 
chewed,  thereby  putting  too  much  of  a  tax  on  the  digestive 
organs. 

Fruits  are  preserved  by  means  of  cold  storage,  and  may 
be  kept  in  excellent  condition,  provided  the  temperature 
does  not  go  below  freezing.  Preservation  by  drying  is 
an  inexpensive  way  of  keeping  fruit,  and  does  not  affect 
the  food  value  to  any  extent,  except  in  the  loss  of  water, 
which  is  remedied  by  soaking  the  fruit  before  cooking  for 
a  sufficient  length  of  time  to  allow  the  reabsorption  of  an 
amount  of  water  equivalent  to  that  which  was  evaporated 
in  the  drying  process.     As  the  drying  process  requires  a 


46  Modern  Dietetics. 

great  many  hours,  the  soaking  process  should  also  be 
allowed  to  go  on  for  several  hours.  In  the  commercially 
dried  fruits  sulphurous  acid  is  used  as  a  preservative  and 
to  prevent  discoloration,  as  the  fresh  fruit  is  exposed  to 
the  sulphur  fumes  before  drying.  Some  of  the  sulphur- 
ous acid  escapes  with  the  moisture,  but  enough  remains 
on  the  fruit  to  have  called  forth  a  protest.  There  is 
probably  not  enough  of  the  sulphur  compound  remaining 
to  harm  a  healthy,  normal  person,  but  there  is  possibility 
of  a  weak  digestive  tract  being  affected  by  it.  Here 
again  the  method  of  cooking  is  an  important  factor  in  the 
palatability  and  digestibility.  If  dried  fruit  is  thor- 
oughly washed,  sufficiently  soaked,  and  not  overcooked, 
it  may  be  made  very  appetizing,  and  is  available  for  those 
who  cannot  afford  the  fresh  fruit.  Canned  fruit  has  as 
much  in  its  favor  as  any  cooked  fruit.  Since  our  can- 
ning factories  are  being  managed  on  such  efficient  and 
sanitary  plans,  there  may  be  some  advantages  in  using 
fruit  or  vegetables  which  are  canned  in  the  same  section 
of  the  country  in  which  they  are  grown.  They  may 
ripen  before  being  gathered  and  are  not  subject  to  the 
deterioration  due  to  transportation,  standing  in  open 
markets,  and  much  handling,  which  fruit  is  apt  to  receive 
before  reaching  the  consumer  unless  it  is  grown  in  the 
vicinity.  Canners  have  better  facilities  for  sterilization 
and  for  keeping  their  fruits  and  vegetables  whole  and  in 
good  condition  than  private  homes  can  possibly  have. 
They  get  the  product  when  it  is  in  the  best  condition  for 
canning,  and  their  scientific  investigations  in  their  own 
laboratories  have  taught  them  the  exact  temperatures 
that  are  best  for  each  material,  how  to  gauge  density  of 
syrups,  and  all  other  important  points  in  preservation 
by  canning. 

Fruits  and  vegetables   put  on   the  market  today   by 


Fruits — Cooked,  Raw,  Canned,  and  Dried.      •    47 

the  better  manufacturers  are  as  wholesome  as  the  home 
article,  and  perhaps  have  been  selected  with  more  care 
than  some  of  our  home  products. 

It  is  quite  essential,  however,  that  we  learn  manufac- 
turers and  their  grades.  We  may  know  the  numbers  indi- 
cating certain  sizes  of  cans  and  observe  the  net  weight 
written  upon  the  can,  but  we  cannot  in  this  way  know 
whether  we  are  paying  for  water  or  for  fruit  in  the  can. 
It  is  well  to  find  a  reliable  brand  and  use  it  as  much  as 
possible.  The  price  is  not  a  safe  guide  either,  as  often  a 
higher  priced  can  will  contain  more  liquid  than  one  with 
a  lower  price. 


CHAPTER  VIII. 
COFFEE,  TEA,  COCOA,  AND  CHOCOLATE. 

COFFEE  AND  TEA  HAVE  PRACTICALLY  NO  NUTRITIVE  VALUE, 
AND  ARE  MERELY  STIMULANTS — COCOA  AND  CHOCOLATE 
ARE  EXCELLENT  FOODS,  BUT  SOME  ADULTERANTS  ARE 
HARMFUL — CEREAL  "COFFEES"   AND  THEIR  USE. 

Cocoa  beans  contain  about  50  percent  fat,  and  the 
greater  part  of  it  is  removed  in  making  cocoa.  Cocoa 
fat  is  solid  at  ordinary  temperature,  and  is  known  as 
cocoa  butter.  It  more  nearly  resembles  butter  fat  than 
any  other  natural  fat  on  the  market.  It  is  not  employed 
so  much  in  cooking,  but  is  used  a  great  deal  in  making 
chocolate  bars  and  coating  chocolate  candy,  and  is  in 
considerable  demand  for  medical  and  pharmaceutical 
preparations. 

Both  protein  and  carbohydrate  are  found  in  tea  and 
coffee  in  very  small  quantities,  but  in  forms  which  are  not 
soluble,  and  therefore  cannot  be  utilized  by  the  body. 
Neither  is  a  food,  but  cocoa  and  chocolate  contain  nutri- 
ents which  the  body  can  use.  Coffee,  tea,  cocoa,  and 
chocolate  are  stimulants,  though  their  properties  for 
stimulating  are  not  equal.  Many  adults  do  not  notice  any 
stimulation  from  cocoa  or  chocolate,  and  it  is  more  apt 
to  be  noticeable  in  children,  especially  if  they  are  taken 
in  concentrated  forms  or  in  large  quantities. 

The  stimulating  property  in  tea  and  coffee  is  due  to 
caffein,  and  in  chocolate  it  is  theobromin.  Tannin,  a  sub- 
stance in  tea  and  coffee,  interferes  with  the  action  of  the 
digestive  juices,  and  more  particularly  with  the  digestion 
of  protein.  In  tea  the  amount  of  tannic  acid  increases 
with  the  time  of  infusion,  and  the  liquid  should  be  al- 
lowed to  stand  on  the  leaves  but  a  very  short  time.   The 

48 


Coffee,  Tea,  Cocoa,  and  Chocolate.  49 

use  of  the  tea  ball  permits  of  the  desirable  properties  be- 
ing dissolved  and  the  leaves  being  removed  before  the 
tannin,  which  dissolves  much  more  slowly,  has  become  a 
part  of  the  tea.  A  most  delicate  infusion  may  also  be  ob- 
tained with  the  samovar.  In  black  tea  some  of  the  tannic 
acid  is  made  less  soluble  by  a  process  of  fermentation. 
This  makes  it  less  astringent  than  green  tea,  and  there  is 
present  a  little  more  of  the  oil,  which  gives  a  flavor  that 
is  considered  better  by  many  people.  The  difference  in 
grades  of  tea  is  due  to  the  difference  in  location  on  the 
plant  from  which  the  leaves  have  been  taken.  The  small 
leaves  at  the  tip  end  of  young  shoots  are  the  choicest, 
while  those  larger  and  farther  down  on  the  plant  are  of 
an  inferior  grade.  Teas  from  different  countries  have  dif- 
ferent flavors,  and  a  blend  of  several  varieties  gives  a 
better  flavor  and  is  more  pungent.  The  use  of  milk  or 
cream  in  tea  is  objected  to  by  connoisseurs ;  there  is  logic, 
however,  in  the  use  of  orange,  lemon,  and  other  fruits  if 
the  brewing  is  done  in  a  pot.  The  acid  of  the  fruit  some- 
what modifies  the  tannic  acid,  though  one  does  not  get  the 
natural  tea  flavor  as  completely  when  it  is  mixed  with 
the  flavor  of  the  fruit. 

The  tannin  in  coffee  is  combined  with  caffein,  and  is 
found  in  smaller  proportion  than  in  tea;  but  so  much 
more  coffee  is  used  per  cup,  however,  that  the  result  is 
much  the  same.  During  roasting  the  aroma  of  coffee  is 
developed  and  some  of  the  acids  are  driven  off.  Mocha, 
Java,  and  Rio  are  the  commoner  brands  of  coffee.  Mocha 
produces  a  delicate,  clear  concoction ;  Java,  a  strong  one ; 
combined,  they  are  a  very  good  blend.  The  caffein  is  dis- 
solved almost  immediately,  and  the  value  of  the  perco- 
lator in  making  coffee  is  similar  to  that  of  the  tea  ball  in 
making  tea.  Coffee  is  sometimes  adulterated  with  chic- 
ory. One  should  not  have  to  pay  coffee  prices  for  chicory, 
but  it  is  a  harmless  adulterant,  and  gives  a  distinctive 


50  Modern  Dietetics. 

flavor  which  is  popular  in  many  European  countries  and 
in  our  own  southern  states.  Cafe  au  lait,  used  much  by 
the  French  especially,  is  made  by  combining  a  strong  cof- 
fee, often  with  the  chicory  in  it,  with  hot  milk.  The  pro- 
portion of  milk  used  is  much  larger  than  that  of  cream 
ordinarily  used,  and,  though  the  coffee  is  very  strong,  it 
is  diluted  to  such  an  extent  by  the  greater  amount  of  milk 
that  it  probably  has  no  more  caffein  than  is  in  coffee  made 
in  the  customary  way.  The  use  of  cream  in  tea  and  coffee 
is  condemned  by  some  authorities  on  the  ground  that  the 
tannic  acid  is  precipitated  by  the  cream,  forming  a  hard 
precipitate,  which  is  irritating  and  indigestible.  Other 
equally  eminent  authorities  say  it  is  better  to  have  this 
harmful  substance  made  insoluble,  so  that  it  may  not  be 
absorbed  by  the  body.  Individuals  are  apt  to  be  advocates 
of  whichever  theory  accords  with  their  tastes.  A  moder- 
ate amount  of  black  coffee  excites  the  flow  of  the  digestive 
juices,  thus  giving  it  the  nature  of  an  appetizer  in  some 
instances ;  or  a  demitasse  at  the  end  of  a  heavy  meal  may 
have  value  as  an  aid  to  the  heavily  taxed  digestive  organs. 
Taken  in  large  amounts,  tea  and  coffee  are  apt  to  be  over- 
stimulating,  and  are  really  nerve  irritants  to  neuras- 
thenic patients.  If  used  in  excess,  coffee  may  be  consti- 
pating ;  on  the  other  hand,  if  taken  in  moderation,  it  may 
serve  as  a  means  of  helping  to  get  more  water  into  the 
system  than  would  otherwise  be  taken.  To  the  average 
healthy  individual,  leading  a  comparatively  active  life, 
there  is  little  harm  in  the  use  of  coffee  if  not  used  to 
excess. 

There  are  many  cereal  "coffees"  on  the  market  whose 
manufacturers  claim  much  for  them.  As  their  name  im- 
plies, they  are  made  of  some  cereal  or  combination  of 
cereals  which  have  been  parched  and  ground.  It  is  true 
that  they  are  not  constipating  nor  overstimulating,  nor 
in  any  other  way  harmful ;  neither  have  they  any  great 


Coffee,  Tea,  Cocoa,  and  Chocolate.  51 

virtue,  as  they  have  no  nutritive  value  of  any  consequence. 
For  one  who  is  harmed  by  the  use  of  tea  or  coffee,  and  yet 
does  not  care  for  plain  water,  these  substitutes  may  in- 
duce him  to  take  more  liquid  than  he  otherwise  would. 

Cocoa  and  chocolate  have  stimulating  properties  due 
to  the  theobromin  present,  but  they  also  contain  fat,  pro- 
tein, and  carbohydrate  in  large  enough  proportions  to 
make  them  of  value  as  food  materials,  and,  with  the  ad- 
dition of  milk,  they  have  considerable  nutritive  value. 
They  are  made  from  the  beans  of  the  cacao  tree.  These 
beans,  which  are  similar  in  size  and  shape  to  almonds, 
are  separated  from  the  long  pod  and  fermented  for  a  few 
days  in  order  to  modify  the  bitter  taste ;  they  are  dried  in 
the  sun  and  roasted  to  develop  the  odor  and  flavor  and 
give  them  the  reddish-brown  color,  after  which  the  hulls 
are  removed  and  the  kernels  crushed.  The  hulls  have 
been  largely  used  as  an  adulterant  for  spices  or  in  making 
a  cheap  grade  of  cocoa,  and  they  have  some  value  as  cattle 
food.  The  kernel  is  ground  to  a  powder,  and,  if  cocoa  is 
desired,  most  of  the  fat  is  removed,  the  amount  remain- 
ing in  the  cocoa  varying  with  different  brands.  One  who 
has  an  intimate  and  accurate  knowledge  of  the  manufac- 
ture of  cocoa  says  this  of  the  process:  "In  the  manu- 
facture of  cocoa  by  the  so-called  'Dutch  process'  the 
ground  mass  is  treated  with  a  caustic  alkali  or  its  car- 
bonate. By  this  treatment  a  part  of  the  oil  of  the  cocoa 
is  converted  into  a  sort  of  soap,  and  the  insoluble  par- 
ticles remain  longer  in  suspension ;  but  this  addition  of  a 
foreign  substance  destroys  the  fine  bright-red  color  of  a 
natural  cocoa  and  impairs  its  flavor  to  such  an  extent 
that  it  is  always  necessary  to  add  an  artificial  flavoring 
matter  to  make  it  palatable."  In  speaking  of  the  use  of 
the  hydrate  or  carbonate  of  sodium  and  potassium  in 
making  cocoa,  he  makes  this  statement:  "This  employ- 
ment is  due  to  the  fact  that  by  their  use  a  lower  grade  of 


52  Modern  Dietetics. 

cocoa  beans  can  be  used  than  in  the  manufacture  of  a 
cocoa  having  no  chemicals."  It  has  been  said  that  these 
alkalies  are  not  harmful,  but  there  is  some  question  about 
that,  particularly  if  the  beverage  is  used  frequently. 
Cocoa  may  be  adulterated  with  ground  hulls,  starch, 
or  by  having  more  fat  removed  than  should  be,  as  cocoa 
butter  is  a  high-priced  article.  Because  of  the  starch 
present,  it  should  be  cooked  long  enough  to  soften  the 
starch  grain,  and  putting  cocoa  into  a  cup  and  pour- 
ing hot  liquid  over  it  will  not  cook  it  sufficiently.  The 
"whitish"  coating  sometimes  found  on  chocolate  does  not 
necessarily  mean  that  it  is  old  or  of  an  inferior  quality. 
Pure  chocolate  will  melt  at  a  temperature  of  about  96°  F. ; 
part  of  the  oil  or  butter  will  rise  to  the  surface.  If  a  cake 
of  chocolate  has  become  warm  enough  to  start  melting, 
then  again  become  cool,  this  cocoa  butter  will  cover  the 
outside  of  the  cake,  giving  it  the  white  appearance. 

If  little  or  none  of  the  fat  is  removed  when  the  bean  is 
ground,  chocolate  is  produced.  Many  people  cannot  as- 
similate so  large  a  proportion  of  fat,  and  therefore  choco- 
late is  better  when  used  with  some  other  material,  such  as 
sugar.  Even  sugar  added  in  candymaking  gives  a  better 
product  than  the  chocolate  alone.  Chocolate  is  often  sub- 
ject to  considerable  adulteration.  Cheaper  fats,  such  as 
beef  stearin,  may  take  the  place  of  cocoa  butter.  Seeds 
may  be  ground  up  with  the  cocoa  bean,  and  even  an  imi- 
tation chocolate  has  been  made  from  gelatin,  sugar,  iron 
oxid,  and  aniline  dye,  with  a  coating  of  shellac  varnish  to 
give  the  gloss  of  the  chocolate  fat.  Theobromin  is  milder 
in  its  effects  than  thein  or  caffein,  but  chocolate  contain- 
ing it  should  not  be  given  to  young  children  in  candy  or 
other  concentrated  forms,  especially  if  they  are  nervous 
and  excitable. 


CHAPTER  IX. 
POULTRY  AS  A  HOSPITAL  FOOD. 

ALL  FOWLS  HAVE  THE  SAME  FOOD  VALUES,  THOUGH  GEESE 
AND  DUCKS  HAVE  TOO  MUCH  FAT  FOR  IMPAIRED  DIGES- 
TION— LITTLE  DIFFERENCE  BETWEEN  WHITE  AND  DARK 
MEAT — VALUE  OF  PROPER  COOKING. 

Poultry  furnishes  another  food  material  which  is  much 
used  in  the  hospital  dietary.  All  domestic  fowls  are  simi- 
lar so  far  as  food  value  is  concerned.  Conditions  which 
influence  the  flavor  and  quality  of  poultry  as  food  are  age 
and  sex,  food  and  care,  killing  and  plucking,  storage, 
dressing,  stuffing,  and  cooking.  Almost  any  breed  may  be 
made  acceptable  for  eating  with  the  proper  care  and  feed- 
ing, though  the  larger  fowls  are  considered  better  than 
the  smaller.  The  young  fowl  is  more  tender  and  more 
delicately  flavored  than  one  which  is  older;  more  growth 
and  exercise  have  made  the  fibers  of  the  older  fowl 
tougher,  but  more  extractives  have  developed,  which 
gives  a  stronger  flavor.  This  is  why  the  flavor  of  wild 
game  is  so  pronounced.  The  flesh  of  young  fowls  which 
have  been  well  fed  and  cared  for  is  more  desirable  than 
that  from  the  neglected  fowl,  the  flesh  of  which  will  be 
tough  and  stringy.  Capons  and  milk-fed  chickens  grow  to 
be  larger  than  the  common  fowls,  and  their  flesh  is  whiter 
and  more  delicately  flavored.  They  are  usually  confined 
in  a  small  area,  and  so  much  care  is  given  to  them  to  make 
their  flesh  of  the  highest  quality  that  they  bring  a  much 
higher  price  on  the  market. 

In  buying  poultry,  one  should  look  to  the  following 
points  for  good  quality:  (1)  a  well-rounded  form,  with 
no  bony  angles,  particularly  on  the  breast;  (2)  a  clear 
skin,  free  from  yellow  blotches — these  blotches  are  indi- 

53 


54  Modern  Dietetics. 

cations  of  long  storage — other  indications  of  long  stor- 
age are  a  leathery  skin  and  soft  muscles,  easily  torn; 
(3)  in  a  young  fowl  the  breast  bone  is  still  cartilage,  be- 
ing soft  and  flexible,  and  the  feet  are  soft  and  smooth — 
not  hard  and  rough;  (4)  in  ducks  and  geese  the  windpipe 
is  flexible  in  a  young  fowl;  (5)  in  squabs  the  flesh  is 
whitish  and  the  feet  red,  and  in  the  older  bird  the  flesh  is 
purplish. 

The  Yearbook  issued  by  the  Agricultural  Department 
says  that,  so  long  as  poultry  is  frozen  solid,  no  harm  is 
done  by  storage.  At  the  meeting  of  the  packers  and  cold 
storage  men  in  Chicago  in  1914,  meats  and  poultry  were 
served  that  had  been  in  storage  for  a  much  longer  time 
than  is  usually  considered  acceptable,  and  yet  the  fine 
flavors  persisted.  No  doubt  much  of  the  criticism  of  cold 
storage  is  due  to  the  manner  of  thawing  and  handling 
after  the  poultry  is  removed  from  storage.  The  practice 
of  thawing  by  dipping  the  fowls  in  tanks  of  water  has 
been  most  repulsive  in  some  instances,  especially  where 
the  water  in  the  tank  was  not  renewed  as  frequently  as 
it  should  have  been,  and  poultry  which  was  in  good  con- 
dition when  taken  out  of  storage  would  be  pretty  well  con- 
taminated after  coming  out  of  the  tank.  It  is  difficult  for 
the  dealer  to  sell  frozen  chickens  to  retail  buyers,  as  few 
realize  that  the  frozen  fowl  may  be  really  safer  than  one 
which  has  been  thawed,  and  the  fact  that  it  is  not  frozen 
is  no  indication  that  it  has  not  been  in  storage.  After  be- 
ing taken  from  the  extremely  low  temperature  into  the 
higher  one  in  the  market,  it  deteriorates  very  rapidly. 

Ducks  and  geese  have  so  much  fat  that  they  are  very 
little  used  in  the  hospital  dietary.  Squabs  and  quails,  etc., 
can  be  used  only  in  hospitals  where  patrons  are  well  to 
do,  but  chicken  is  used  almost  daily  for  all  classes  of  pa- 
tients and  in  all  hospitals. 

The  difference  in  food  value  of  dark  and  light  meat  is 


Poultry  as  a  Hospital  Food.  55 

a  negligible  quantity.  There  is  a  lesser  amount  of  fat  in 
the  light  meat,  but  there  is  not  enough  in  the  dark  meat 
to  be  given  any  consideration  dietetically.  The  dark  meat 
may  have  very  slightly  more  extractives,  and  conse- 
quently may  be  more  highly  flavored.  There  was  formerly 
a  prejudice  in  favor  of  using  white  meat  for  a  patient 
when  he  was  beginning  to  eat  his  first  solid  food,  and  for- 
bidding the  dark,  but  the  only  reason,  however,  for  this 
is  that  the  white  meat  is  more  tender  and  more  easily 
masticated. 

Cooking  plays  as  important  a  part  in  the  desirability 
and  digestibility  of  chicken  as  any  other  factor.  What 
may  be  said  of  the  cooking  of  chicken  may  be  said  of  all 
nieat — if  any  microorganisms  are  present,  they  are  killed 
by  the  cooking  process ;  flavors  are  developed  which  com- 
pletely alter  the  taste ;  the  fibers  and  intercellular  tissues 
are  softened  and  made  more  easily  digested.  Cooking 
meat  too  long,  or  at  too  high  a  temperature,  will  dry  up 
the  juices,  making  it  tasteless,  and  toughens  the  fibers  so 
that  they  are  not  readily  broken  down  by  the  digestive 
juices. 


CHAPTER  X. 
EGGS  AS  A  STAPLE  ARTICLE  OF  DIET. 

VALUE  DUE  TO  LARGE  AMOUNT  OF  NUTRITION — MILDNESS 
OF  FLAVOR  FACILITATES  THEIR  USE  IN  COMBINATION 
WITH  OTHER  FOODS — FRESH  EGGS — CAUSES  AND  CURE  OF 
RANCIDITY — EGG  DISHES. 

It  has  been  said  that  eggs  are  as  indispensable  in  cook- 
ing as  the  word  "the"  is  in  conversation.  This  may  be  at- 
tributed to  the  fact  that  eggs  are  of  high  nutritive  value, 
are  easily  digested,  very  well  absorbed,  and  have  a  mild 
flavor  which  makes  it  possible  to  combine  them  with  a 
great  variety  of  other  food  materials.  They  may  be  used 
in  omelets,  cake,  etc.,  as  a  leavening  agent ;  in  custards  and 
sauces  for  thickening  purposes ;  and  for  adhesive  purposes 
in  croquettes,  cutlets,  etc.  Their  value  as  a  food  depends  a 
great  deal  on  their  freshness  and  the  manner  in  which 
they  are  cooked.  Perfectly  fresh  eggs  are  liked  by  almost 
everyone,  but,  if  kept  at  ordinary  room  temperature,  the 
flavor  soon  deteriorates.  As  the  shells  are  porous,  their 
contents  may  be  quickly  contaminated,  and  therefore  eggs 
should  not  be  kept  near  anything  which  has  a  strong  or 
disagreeable  odor,  nor  should  they  be  packed  in  any 
material  which  has  a  disagreeable  odor. 

Eggs  kept  for  a  considerable  time  in  a  warm  room  will 
have  alkaline  substances  produced — presumably  from  the 
white.  If  air  does  not  reach  the  inside,  and  if  they  are 
kept  at  a  low  temperature,  this  chemical  action  takes 
place  more  slowly.  Many  devices  are  used  to  prevent  the 
loss  of  water  by  evaporation  and  the  passing  of  air  into 
the  egg;  coating  the  outside  of  the  shell  with  petroleum 
is  probably  the  most  effective  means,  but  it  is  likewise  the 
most  expensive  and  requires  too  much  time  to  be  prac- 

56 


Eggs  as  a  Staple  Article  of  Diet.  57 

tical.  Eggs  may  be  preserved  in  a  solution  of  lime  water 
or  in  salt  water,  but  these  penetrate  the  shell,  and  after 
a  time  affect  the  taste  of  the  egg.  Sodium  silicate  (water 
glass)  has  proved  to  be  very  satisfactory  in  preserving 
eggs.  By  this  means  eggs  may  be  kept  several  months 
with  very  little,  if  any,  change  in  the  flavor.  The  yolk 
retains  its  normal  position,  and  the  eggs  are  more  nearly 
like  fresh  ones  than  if  preserved  in  any  other  of  the  ordi- 
nary ways.  The  shells  of  eggs  so  kept  crack  very  easily, 
necessitating  careful  handling,  and  the  eggs  must  be  used 
very  soon  after  being  removed  from  the  solution. 

Storage  at  a  temperature  of  32°  to  34°  F.  in  a  clean, 
pure  atmosphere  will  arrest  bacterial  development  in 
eggs,  and  there  will  be  comparatively  little  change  in 
four  or  five  months,  though  after  that  the  change  is  more 
or  less  pronounced,  according  to  the  method  of  storage 
and  length  of  time  kept,  and,  if  not  turned  frequently,  the 
yolk  adheres  to  one  side.  The  amount  of  moisture  in  the 
cold  storage  chamber  is  important,  as  the  evaporation 
must  be  kept  low,  and  the  eggs  should  not  be  allowed  to 
stand  for  any  length  of  time  in  a  higher  temperature 
after  being  removed  from  cold  storage.  Unfertile  or 
sterile  eggs  keep  much  better  than  the  fertile  ones,  and 
poultry  dealers  are  giving  more  attention  to  the  pro- 
ducing of  sterile  eggs.  In  many  cities  sterile  eggs  can 
be  obtained  in  large  quantities  direct  from  the  farm,  and 
these  may  be  kept  for  many  weeks  without  any  change 
in  flavor  if  kept  in  a  clean  place. 

Like  all  foods  high  in  protein  content,  eggs  should  be 
cooked  at  a  low  temperature  in  order  to  prevent  toughen- 
ing the  albumen.  Water  should  not  be  allowed  to  boil 
while  the  egg  is  in  it,  whether  the  egg  is  being  cooked  in 
the  shell  or  out  of  it  (poached).  The  length  of  time  for 
cooking  depends  on  the  amount  of  heat  used,  number  of 
eggs  being  cooked,  whether  the  eggs  are  very  cold  when 


58  Modern  Dietetics. 

placed  in  the  water,  the  size  and  freshness  of  the  eggs,  the 
size  of  the  pan  and  the  material  of  which  it  is  made,  and 
the  amount  of  water  used.  The  idea  that  an  egg  should 
boil  three  minutes  is  not  logical,  and  is  not  worthy  of 
much  faith.  Practically  no  two  households  will  be  found 
where  the  above-mentioned  conditions  are  identical  or 
even  similar,  and  it  would  be  impossible  to  obtain  uniform 
results  when  the  only  uniform  condition  is  the  time. 
Fried  eggs  are  generally  considered  difficult  to  digest,  and 
this  is  probably  true  if  they  are  fried  at  a  temperature 
high  enough  to  toughen  the  protein  or  to  decompose  the 
fat  used.  As  butter  is  the  favorite  fat  for  frying  eggs  and 
its  "cracking  point"  is  low,  irritating  acids  are  apt  to  be 
formed.  The  smoking  of  the  fat  means  that  the  acids  are 
present,  and  many  people  wait  for  this  "sign  that  the  fat 
is  hot  enough  for  use"  before  dropping  the  eggs  into  it. 
The  coating  of  fat  may  be  difficult  for  the  digestive  juices 
to  penetrate,  and  thus  cause  trouble  for  a  weak  digestion. 

Soft-cooked  eggs  are  the  most  readily  digested,  though 
hard-cooked  eggs  are  as  completely  digested  and  assimi- 
lated, the  difference  being  in  the  length  of  time  required, 
provided  the  hard-cooked  are  well  masticated.  Raw  eggs 
are  not  so  easily  digested  as  slightly  cooked  ones,  and  the 
mistaken  idea  in  regard  to  this  matter  has  given  rise  to 
the  use  of  raw  eggs  with  the  sick  to  a  much  greater  extent 
than  is  warranted  by  the  facts. 

Eggs  are  a  concentrated  form  of  food,  and  during  the 
greater  part  of  the  year  might  be  classed  as  inexpensive. 
At  35  cents  or  more  per  dozen  they  cannot  be  used  freely 
in  a  family  of  limited  means,  but  in  combination  with  a 
white  sauce  they  may  be  served  at  less  cost  as  an  omelet ; 
or  they  may  be  hard-boiled  and  chopped  or  sliced,  and, 
with  the  white  sauce,  they  make  a  very  good  substitute 
for  meat  in  the  diet  and  require  less  fuel  for  cooking. 
Instead  of  the  white  sauce,  the  cost  may  be  further  re- 


Eggs  as  a  Staple  Ay^ticle  of  Diet,  59 

duced  if  bread  crumbs  and  milk  are  used,  and  still  other 
very  palatable  and  nutritious  combinations  may  be  made. 
Grated  cheese  and  pieces  of  meat  not  usable  by  themselves 
may  be  added  to  form  a  substantial  dish.  When  one  does 
not  need  to  restrict  the  number  used,  most  appetizing 
souffles  and  desserts  are  a  pleasing  change  from  puddings 
and  pies.  Because  of  their  ease  of  digestion  and  the  com- 
pleteness of  their  absorption,  eggs  are  desirable  for  peo- 
ple with  impaired  or  weak  digestion.  Other  advantages 
of  eggs  as  a  food  are  that  they  contain  no  injurious  sub- 
stances, such  as  may  be  found  in  other  animal  forms. 

There  is  a  tendency  on  the  part  of  the  public  to  be  sus- 
picious of  hospital  eggs.  Whether  there  is  any  justifica- 
tion for  this  suspicion,  there  certainly  is  no  reason  why 
hospitals  should  not  serve  good  eggs.  Even  if  the  financial 
situation  will  not  permit  the  buying  of  strictly  fresh  eggs, 
a  candling  apparatus  may  be  devised  with  practically  no 
expense  and  very  little  time  and  trouble.  Not  a  great  deal 
of  time  is  required  to  candle  a  case  of  eggs,  and  the 
trouble  is  far  more  than  counterbalanced  by  the  satisfac- 
tion of  knowing  that  the  patients  and  others  are  being 
served  only  good  eggs.  It  is  most  deplorable  for  a  sick 
person,  or  even  a  well  person,  to  attempt  to  eat  an  egg 
that  causes  nausea  and  perhaps  a  dislike  for  eggs  the  rest 
of  his  life ;  and,  incidentally,  it  is  most  humiliating  for  a 
dietitian  to  be  told  that  such  a  thing  has  occurred  in  her 
domain. 

At  the  Cook  County  Infirmary,  Oak  Forest,  111.,  the 
chief  engineer  made  for  the  writer  an  admirable  candling 
device.  It  consisted  of  a  tin  tube,  fitted  to  a  standard, 
with  holes  cut  into  it  for  the  eggs  and  an  extension  above 
for  the  light.  It  was  a  very  efficient  as  well  as  a  pre- 
sentable piece  of  apparatus,  and  cost  but  a  few  cents.  It 
was  used  in  a  small  store  room  that  had  no  window,  and 


60  Modern  Dietetics. 

air  was  provided  by  leaving  the  door  open  and  hanging 
a  black  curtain  in  the  entrance. 

At  another  time  an  ordinary  tin  box  was  used  with 
very  good  results.  Holes  were  cut  into  the  side  of  the 
box  large  enough  for  eggs  to  be  held  in  front  of  them,  an 
electric  bulb  was  inserted,  and  the  box  tightly  closed  to 
exclude  all  other  light.  This  apparatus  will  not  permit 
of  close  grading,  but  it  enables  the  candler  to  determine 
by  spots  and  air  spaces  which  eggs  are  suitable  for 
eating.  Wherever,  however,  it  is  possible  to  obtain  the 
infertile  eggs,  the  results  more  than  justify  the  effort. 


CHAPTER  XI. 
MEATS— THEIR  STORAGE  AND  PREPARATION. 

FEEDING  VALUES  AND  RELATIVE  AVAILABILITY  OF  BEEF, 
VEAL,  MUTTON,  PORK,  LIVER,  AND  SWEETBREADS — CHOICE 
CUTS  AND  METHODS  OF  PREPARATION — CURING  PROC- 
ESSES OF  MEATS — BEEF  JUICE  AND  BEEF  TEA. 

If  meat  is  used  as  a  food  material  itself,  it  should  be 
submitted  to  a  high  temperature  at  first  in  order  to  sear 
the  outer  surface  and  retain  the  juices,  and  then  the  tem- 
perature should  be  lowered  for  the  rest  of  the  cooking, 
as  in  roasting  and  broiling — that  is,  the  outer  crust  is 
sacrificed  for  the  sake  of  improving  the  remainder.  If 
both  meat  and  broth  are  to  be  used,  as  in  stews  and  fricas- 
see, a  slow  cooking  is  required  at  a  low  temperature  in  a 
well-covered  kettle,  and  in  this  way  a  very  acceptable  food 
may  be  obtained  from  a  tough  piece  of  meat.  If  only 
the  broth  is  to  be  used,  the  meat  should  be  cut  into  small 
pieces  in  order  to  expose  the  largest  possible  surface ;  it 
should  be  put  in  cold  water  and  allowed  to  stand  a  half 
hour  in  order  to  dissolve  out  the  proteins  which  are 
soluble  in  cold  water;  it  should  then  be  cooked  slowly  in 
a  tightly  covered  vessel  in  order  to  retain  all  the  flavor. 
Not  less  than  an  hour,  and  more  if  possible,  should  be 
allowed  for  a  quart  of  broth  to  cook,  but  it  should  not  be 
permitted  to  boil.  By  this  process  all  the  soluble  pro- 
teins, extractives,  and  mineral  salts  are  in  the  broth, 
which  should  be  poured  off  the  meat,  but  not  strained. 
The  flocculent  particles  are  the  protein,  and  should  be 
given  unless  the  patient  is  in  such  an  extreme  condition 
that  even  these  minute  bits  of  solid  matter  disturb  him. 

Commercially  prepared  bouillon  cubes  and  meat  ex- 
tracts are  sold,  to  which  has  been  attributed  more  value 

61 


62  Modern  Dietetics. 

than  their  composition  warrants.  The  impression  has 
been  given  that  they  are  a  concentrated  form  of  meat, 
especially  valuable  for  invalids,  though  for  most  of 
them  their  advertisers  do  not  claim  that  they  are  beef 
broth  or  essence.  In  a  bulletin  issued  by  the  United 
States  Department  of  Agriculture  the  chief  constituent 
of  bouillon  cubes  is  given  as  common  salt,  meat  extract 
being  present  in  small  amounts.  An  extract  of  plant  or 
vegetable  is  also  used  in  small  amounts  to  give  flavor. 
"The  bouillon  cubes  on  the  market  are  sold  at  from  1  to 
2  cents  each,  and  it  takes  from  15  to  20  cubes  to  weigh 
2  ounces.  This  would  make  the  cost  of  2  ounces  of 
bouillon  cubes  25  to  40  cents.  It  is,  therefore,  apparent 
that  the  cubes,  which  contain  about  two-thirds  salt  and 
never  more  than  28  percent  meat  extract,  are  an  expen- 
sive form  of  securing  meat  extract.  The  45  cents,  if 
spent  for  semisolid  meat  extracts,  will  purchase  two  to 
three  times  the  amount  of  meat  extract  that  it  is  possible 
to  obtain  for  the  same  money  in  the  form  of  bouillon 
cubes." 

For  young  and  tender  meats,  broiling  and  roasting  give 
the  best  results.  Older  and  tougher  fibers  are  much 
more  difficult  to  make  palatable  in  this  way,  and  stewing, 
boiling,  en  casserole,  etc.,  are  more  satisfactory  ways  of 
serving  them.  In  roasting  and  broiling,  no  fat  should  be 
allowed  to  accumulate  in  the  pan,  as  it  will  coat  the  outer 
surface  of  the  meat,  and  it  will  be  difficult  for  the 
digestive  juices  to  penetrate  the  crust  thus  formed. 

All  meats  have  much  the  same  composition,  that  from 
different  animals  varying  chiefly  in  the  proportion  of  the 
constituents.  Lean  meat  is  made  up  of  bundles  of  fibers 
held  together  by  connective  tissue,  with  varying  quanti- 
ties of  fat  scattered  through  and  between  the  mem- 
branes. There  are  many  forms  of  protein  in  meat — 
albumin  in  the  blood  and  muscle ;  collagen,  which  becomes 


Meats — Their  Storage  and  Preparation.  63 

gelatin  when  cooked,  in  the  skin,  connective  tissue,  ten- 
dons, and  bone;  fibrin,  a  substance  in  the  blood  which 
causes  it  to  coagulate  and  form  a  clot  when  exposed  to 
air ;  myosin  in  the  muscles  and  tendons,  which  causes  the 
stiffening  of  muscles  after  death,  known  as  rigor  mortis ; 
albumin  and  globulin  in  the  blood,  and  many  others.  As 
some  of  these  are  soluble  in  cold  water  and  some  are  not, 
the  manner  of  cooking  figures  largely  in  the  results  we 
get  when  the  meat  is  prepared  for  serving. 

After  an  animal  is  slaughtered,  the  meat  passes 
through  three  stages.  In  the  first  stage,  immediately 
after  death,  the  meat  is  usable ;  in  the  second  stage,  rigor 
mortis  has  taken  place  and  it  is  not  suitable  for  food ;  in 
the  third  stage  acids  have  developed  which  soften  the 
muscle  fibers,  and  it  is  again  fit  for  food.  This  is  known 
as  the  "ripening"  process.  When  vinegar  or  other  acid 
is  rubbed  on  tough  meat  in  order  to  soften  the  fibers  and 
make  it  more  tender,  this  natural  process  is  simply  carried 
out  artificially. 

Our  most  expensive  cuts  of  meat  are  taken  from  the 
parts  of  the  animal  which  are  least  exercised.  They  are 
the  more  tender  and  fine-grained  parts,  but  they  have  less 
juice  and  extractives.  The  tenderloin  and  porterhouse 
steaks  are  cut  from  the  portion  where  there  is  little  or  no 
exercise  of  the  muscle,  while  the  round  and  the  flank 
steaks  are  from  the  leg  or  just  in  front  of  it,  where  the 
muscle  is  much  exercised ;  the  latter  are  just  as  nutritious 
and  more  highly  flavored,  and,  with  proper  cooking,  they 
may  be  made  very  palatable;  owing  to  the  prevalent 
American  habit,  or  cultivated  taste,  which  demands 
delicate  flavors,  the  first  mentioned  are  much  higher 
priced. 

Beef  should  be  fine  grained  and  well  mottled  with  fat ; 
the  lean  should  be  bright  red ;  the  fat  firm,  yellowish,  and 
should  crumble  easily.     Beef  has  no  very  pronounced 


64  Modern  Dietetics. 

flavor,  and  consequently  it  palls  on  the  appetite  less  than 
pork  or  lamb.  Veal  has  less  fat  and  is  less  nutritious 
than  beef,  its  connective  tissue  has  more  gelatin,  and  it 
should  be  thoroughly  cooked,  while  beef  is  preferred  rare 
by  most  people.  Veal  broth  is  considered  next  to  chicken 
in  delicacy.  There  are  some  contentions  to  the  effect 
that  veal  is  difficult  to  digest,  but,  if  thoroughly  cooked 
and  properly  masticated,  there  is  nothing  about  veal  to 
give  any  trouble  in  digestion.  Dr.  Lorand,  of  Carlsbad, 
uses  veal  and  chicken  in  the  same  way  in  diets  for  delicate 
people,  and  gives  veal  preference  over  beef  as  a  food. 

Lamb  is  less  easily  digested  on  account  of  the  greater 
amount  and  the  higher  melting  point  of  its  fats.  It  has 
a  strong  flavor.  If  the  outside  skin  comes  off  easily, 
the  mutton  is  good.  Mutton  should  be  of  a  pinkish  color 
and  the  fat  hard  and  flaky.  In  lamb  chops  the  bone  is 
red,  but  in  mutton  chops  it  is  not.  Lamb  must  be  well 
cooked,  but  mutton  need  not  be. 

Fresh  pork,  owing  to  its  high  percentage  of  fat,  is  diffi- 
cult to  digest,  but,  if  cured  or  smoked,  it  is  not.  It  must 
be  very  thoroughly  cooked  because  of  the  possible  pres- 
ence of  trichinae.  Trichinae  withstand  the  action  of  heat 
and  smoke  if  applied  only  in  moderation,  and  may  be 
transmitted  to  the  human  being  through  the  eating  of 
pork  meat.  Pork  is  frequently  spoken  of  as  an  unclean 
food  because  of  the  unclean  habits  of  the  hog,  but  the 
gastric  juice  of  the  hog  is  exceptionally  efficacious  and 
will  transform  anything  the  animal  eats.  The  fat  of 
bacon  is  in  granular  form  and  is  easy  of  digestion.  Ham 
is  not  difficult  of  digestion.  Ham  and  bacon  are  sugar- 
cured  and  smoked,  which  gives  them  a  good  flavor  and 
makes  them  keep  well. 

Liver  has  much  protein  and  carbohydrate  in  compari- 
son with  other  meats,  and  is  valuable  in  a  diet  requiring 
high  iron  content. 


Meats — Their'  Storage  and  Preparation.  65 

Sweetbreads  appear  prenatally  in  the  calf  and  disap- 
pear after  the  animal  has  ceased  to  live  on  milk.  The 
thymus  or  throat  sweetbread  is  the  thymus  gland  of  the 
calf,  and  the  belly  sweetbread  is  the  pancreas.  Often  the 
pancreas  of  the  hog  is  sold  as  "stomach  sweetbread." 
Sweetbreads  are  easy  of  digestion,  but  contain  a  large 
percent  of  nucleoprotein,  a  form  of  protein  which  is  richer 
in  purin-yielding  components  than  other  forms,  and  are 
contraindicated  in  cases  of  gout.  They  may  be  served 
in  many  ways,  but  they  are  expensive  and  spoil  easily. 

For  those  who  desire  the  nourishment  of  meat,  and 
yet  are  not  able  to  digest  it  in  the  ordinary  way,  the 
pulp  may  be  separated  from  the  fiber  by  scraping  a  thick 
piece  of  beef  with  the  dull  edge  of  a  knife  or  with  a  spoon. 
It  should  be  scraped  lengthwise  of  the  fiber,  so  as  not  to 
break  the  fiber  or  get  any  of  it  in  the  pulp.  It  may  be 
made  into  sandwiches,  or  formed  into  balls  and  seared  in 
a  hot  pan  without  any  fat.  The  value  of  the  meat  ball 
is  apt  to  be  counteracted  in  the  cooking  unless  done  by 
a  skilled  person,  as  it  is  very  easily  overcooked  and  the 
protein  hardened  until  it  is  as  bad  as  the  fiber  in  the 
original  piece  of  meat.  The  juice  may  be  extracted  by 
subjecting  the  meat  to  high  pressure,  which  is  beneficial 
in  cases  of  severe  gastric  disturbance,  in  typhoid,  and  for 
infants  after  one  year  of  age.  Care  should  be  taken,  in 
warming  the  juice  for  serving,  not  to  overheat  it.  Beef 
juice  contains  fourteen  times  as  much  protein  as  the  aver- 
age beef  tea,  but  the  beef  tea  is  richer  in  flavor,  and  the 
two  are  very  good  when  combined. 

Meats  are  a  cheap  source  of  protein.  They  are  a  con- 
centrated food,  and,  because  of  the  small  amount  of 
"ballast,"  they  are  readily  attacked  by  the  digestive  juices 
and  quite  completely  absorbed.  As  a  people  we  eat  too 
much  meat;  especially  persons  leading  sedentary  lives 
should  not  eat  meat  three  times  a  day.     So  much  meat  is 


66  Modern  Dietetics. 

not  needed,  nor  can  it  be  cared  for  in  the  body  except  by 
one  who  does  hard,  physical  labor  or  lives  out  of  doors, 
or  does  both ;  but  nevertheless  there  is  probably  no  hos- 
pital of  any  pretentions  as  to  size  where  meat  is  not 
served  three  times  daily  to  its  private  room  patients,  and 
the  dietitian  cannot  with  impunity  attempt  to  change 
this  order.  The  majority  of  people  with  whom  one  dis- 
cusses the  subject  will  speak  deploringly  of  the  use  of 
so  much  meat,  but  no  one  except  the  physicians  will  ever 
be  able  to  alter  the  custom,  and  not  until  they  convince 
their  patients  that  it  is  a  harmful  practice  will  there  be 
any  improvement. 


CHAPTER  XII. 
FISH  AND  OYSTERS  IN  THE  DIETARY. 

OYSTERS  ARE  SIMILAR  TO  MILK  IN  FOOD  VALUE — OILY 
FISHES  MORE  NUTRITIOUS  THAN  OTHERS — SOME  SUPER- 
STITIONS EXPLODED — FRESHNESS  OF  GREAT  IMPORTANCE 
— HOW  FLAVOR  OF  OYSTERS  IS  AFFECTED. 

Fish  is  perhaps  the  most  natural  substitute  for  meat, 
as  its  nutritive  value  is  much  the  same,  with  the  excep- 
tion that  it  contains  a  smaller  percent  of  protein.  Fish 
has  few  extractives,  and  has  therefore  no  very  decided 
flavor.  The  oily  fishes — salmon,  mackerel,  and  herring 
— have  higher  food  value  than  the  nonoily — ^perch,  cod, 
trout.  The  theory  that  fish  is  a  brain  food  has  long 
been  exploded,  not  only  because  we  know  there  are  no 
"brain  foods,"  but  there  is  no  justification  for  the 
statement  that  fish  is  rich  in  phosphorus. 

There  is  no  more  waste  in  fish  than  in  most  animal 
foods,  and  it  is  less  expensive.  It  serves  as  a  variety  in 
the  diet,  and,  as  a  rule,  is  easily  digested,  which  makes 
it  well  adapted  to  people  living  a  sedentary  life.  This 
statement  does  not  apply  to  lobster,  shrimp,  and  those 
varieties  of  fish  which  are  very  "rich"  foods  and  have  no 
place  on  a  hospital  dietary.  Oysters  somewhat  resemble 
milk  in  regard  to  amount  and  proportion  of  nutriment. 
They  are  extremely  easy  of  digestion,  and  should  be  only 
slightly  cooked,  but  probably  are  more  readily  digested  if 
not  cooked  at  all.  Combined  with  milk  and  butter  and 
served  with  crackers,  in  the  form  of  a  stew,  or  thickened 
with  a  larger  proportion  of  cracker  or  bread  crumbs 
in  an  escallop,  they  are  a  very  good  food  for  convales- 
cents or  people  who  are  exercising  but  little.  The 
carbohydrate  in  oysters  is  in  the  form  of  glycogen. 

67 


68  Modern  Dietetics. 

There  is  a  question  in  regard  to  the  eating  of  raw  oys- 
ters. They  may  have  been  "floated"  in  unclean  water, 
or,  if  the  oyster  bed  is  near  a  city,  there  is  danger  of 
sewage  contamination  and  typhoid  "germs."  The  flavor 
of  oysters  is  affected  by  the  locality  in  which  grown  and 
also  by  the  season  of  the  year.  They  must  be  kept  in  a 
very  low  temperature,  as  they  spoil  quickly,  and  should 
not  be  eaten  after  being  in  a  warm  room  for  any  consid- 
erable length  of  time,  but  this  same  statement  may  be 
made  concerning  any  form  of  fish.  In  the  decomposition 
of  animal  tissue,  poisonous  substances  called  ptomaines 
are  formed,  which  are  the  result  of  bacterial  action,  and 
which  is  quite  apt  to  accompany  putrefaction.  Occasion- 
ally oysters  are  seen  with  a  green  color,  which  may  be  due 
to  a  plant  on  which  they  feed  or  it  may  be  due  to  the 
presence  of  copper.  If  it  is  a  grass-green  color  and  there 
is  a  slimy  verdigris-like  secretion  in  the  folds,  it  is  due  to 
copper;  but  if  a  dark-green,  it  is  due  to  the  plant  on 
which  the  oyster  fed.  Some  seasons  there  are  found  on 
the  market  a  pink  variety,  but  the  peculiar  color,  unless 
it  is  from  the  copper,  neither  adds  to  nor  detracts  from 
the  food  value  of  the  oyster. 


CHAPTER  XIII. 
SPECIAL  DIETS  IN  DISEASE. 

CERTAIN  DISEASES  THE  RESULT  OF  FAULTY  USE  OF  FOOD  BY 
THE  SYSTEM — TREATMENT  MOSTLY  DIETETIC — SPECIAL 
DIETS  NECESSARY,  BUT  MUST  BE  USED  WITH  INTELLI- 
GENCE— LISTS  OF  DIETS. 

In  practically  all  metabolic  diseases  the  difficulty  is  due 
to  lack  of  proper  metabolism  of  one  or  more  of  the  food 
constituents — carbohydrates,  fats,  or  proteins.  As  has 
been  stated  before,  the  nourishment  of  the  body  depends 
not  on  the  food  which  is  eaten,  but  on  that  which  is  as- 
similated. Food  may  be  of  the  right  kind,  the  right  quan- 
tity, and  be  well  cooked,  yet  the  body  may  not  be  able  to 
utilize  it.  Obesity,  diebetes,  gout,  dyspepsia,  and  all  other 
diseases  in  which  diet  plays  a  large  part  in  the  treatment, 
may  very  frequently  be  traced  to  improper  eating,  bad 
hygiene,  or  overfatigue,  or  a  combination  of  all  these. 

If  the  food  is  not  thoroughly  masticated,  the  particles 
may  be  so  large  that  the  digestive  juices  cannot  penetrate 
them  and  they  are  not  all  digested;  or  the  food  may  be 
too  long  in  the  stomach  or  intestines  and  may  be  decom- 
posed. In  either  case  the  digestive  organs  are  overtaxed, 
and,  following  a  natural  law,  they  will  eventually  wear 
out  or  rebel  in  some  manner.  Overeating  has  the  same 
effect;  irregular  eating,  or  eating  just  previous  to  or  fol- 
lowing a  great  mental  or  physical  effort,  interferes  with 
digestion.  The  secretions  of  the  digestive  tract  are  af- 
fected by  fatigue  and  such  emotions  as  fear,  anger,  and 
grief.  No  doubt  many  "attacks"  of  indigestion  have  been 
brought  on  by  dwelling  on  trouble  or  business  cares  while 
eating. 

Indigestion  and  constipation  are  apt  to  be  forerunners 

69 


70  Modern  Dietetics. 

of  these  diseases  of  metabolism.  If  attended  to  in  time, 
removing  the  cause  may  be  all  that  is  necessary  for  cure 
or  prevention  of  the  disease.  Fothergill  says  that  pro- 
tection from  indigestion  has  saved  many  lives.  Imperfect 
elimination  of  waste  causes  poisonous  substances  to  be 
formed;  fermentation  in  the  intestines  produces  gases 
which  cause  the  stomach  to  be  distended,  which  may  inter- 
fere with  muscular  activity;  or  inflammation  may  be 
caused  by  coarse  particles  of  food.  In  any  of  these  con- 
ditions headache  or  other  discomforts  result,  warning  the 
individual  of  his  indiscretion. 

Constipation  may  be  due  to  imperfect  peristalsis,  intes- 
tinal obstruction,  too  highly  concentrated  or  too  nu- 
tritious food,  insufficient  food  or  insuflficient  fluid,  as- 
tringent food,  irregularity  in  diet  or  lack  of  exercise. 
These  conditions  may  be  overcome  by  eating  an  abund- 
ance of  coarse  foods,  in  order  to  furnish  the  bulk  neces- 
sary to  stimulate  peristalsis,  and  by  drinking  plenty  of 
water.  Fruits  are  very  beneficial  in  constipation,  as  the 
acids  stimulate  the  flow  of  the  secretions,  and  the  cellulose 
furnishes  the  necessary  bulk,  particularly  if  the  skins  are 
eaten.  If  one  or  more  of  the  conditions  mentioned  above 
are  allowed  to  exist  for  any  considerable  length  of  time, 
some  metabolic  disease  is  very  apt  to  develop. 

Medical  men  are  depending  less  on  the  use  of  drugs  and 
more  on  diet  in  the  treatment  of  these  and  many  other 
diseases.  Dietetic  treatment  cannot  be  given  mechan- 
ically, as  a  diet  list  may  be  made  up  which  includes  every 
food  desirable  for  a  given  disease  and  none  that  is  unde- 
sirable, and  yet  there  will  be  few  cases  where  such  a  list 
could  be  used  without  variation.  For  successful  treat- 
ment, there  must  be  close  cooperation  between  the  dieti- 
tian and  the  medical  man.  The  physician,  knowing  the 
condition  of  the  patient  and  following  his  symptoms  from 
day  to  day,  can  suggest  necessary  changes  in  diet;  but, 


Special  Diets  in  Disease.  71 

as  a  rule,  the  medical  man  has  no  time  to  go  into  the  detail 
of  food  composition,  the  effect  of  heat  on  food  materials, 
and  chemical  changes  which  take  place  in  some  foods 
during  cooking,  to  the  extent  that  the  well-trained  dieti- 
tian of  today  has  been  taught  to  do.  All  of  these  matters 
are  important  factors  in  the  digestibility  and  assimila- 
bility  of  food,  and  should  be  given  consideration  in  pre- 
scribing a  diet.  Then,  too,  the  personal  element  must  be 
taken  into  account,  as  many  times  a  food  that  would  be 
given  to  a  young  person  would  not  be  acceptable  to  an 
elderly  one.  The  physical  condition,  previous  environ- 
ment and  habits,  personal  idiosyncrasies,  and  probable 
complication  of  other  diseases  than  the  one  being  treated, 
may  modify  the  diet  to  a  greater  or  less  extent.  Patients 
who  will  submit  willingly  to  the  care  or  the  physical 
treatment,  no  matter  how  painful  or  disagreeable,  which 
their  physician  tells  them  is  necessary,  will  positively  re- 
fuse to  eat  food  of  which  they  are  not  fond,  or  which  is 
prepared  in  a  way  they  do  not  like.  A  patient  should  be 
given,  as  far  as  possible,  the  things  he  enjoys.  If  the  die- 
titian knows  his  likes  and  dislikes,  she  may  be  able  to 
give  them  consideration  in  the  majority  of  instances ;  but, 
when  it  is  not  possible  to  do  so,  the  physician  can  do  more 
than  anyone  else  to  reconcile  him  to  the  diet.  Very  few 
kitchens  are  adequately  equipped  and  provided  with 
enough  people  to  give  good  service  to  the  entire  house,  and 
take  care  of  many  special  diets  and  special  orders.  Physi- 
cians who  are  not  familiar  with  the  prevailing  situation 
have  been  known  to  ask  for  so  many  extra  things  that  it 
would  be  impossible  to  provide  them,  and  many  times  a 
satisfactory  substitute  could  well  be  given  with  no  incon- 
venience to  anyone.  If  there  are  twenty-five  or  thirty  pa- 
tients getting  special  diets  in  various  parts  of  the  house, 
representing  different  physicians'  ideas  of  treatment, 
with  perhaps  as  many  more  patients  having  special  things 


72  Modern  Dietetics. 

ordered  for  them,  and  almost  an  equal  number  of  things 
brought  to  the  patient  by  friends  and  sent  to  the  kitchen 
for  preparation  and  serving,  great  inroads  are  made  on 
the  time  of  the  kitchen  help,  and  there  must  be  a  way  of 
regulating  this  condition. 

A  prescribed  diet  list  for  any  specific  disease  is  no 
longer  found  to  give  the  best  results.  The  day  of  the 
special  diet  list  is  passing  in  the  hospital  and  we  are 
giving  individual  treatment  instead.  Instead  of  deter- 
mining what  foods  a  patient  may  or  may  not  have,  we 
ascertain  his  tolerance  for  carbohydrates,  proteins,  and 
fat.  This  requires  knowledge  and  skill  as  well  as  much 
work  on  the  part  of  the  dietary  department,  but  all  this 
is  more  than  counteracted  in  the  satisfying  results 
obtained.  Individual  treatment  can  be  given  successfully 
only  when  there  is  close  cooperation  between  the  doctors, 
nurses,  and  dietitians.  Very  few  nurses  have  had  suffi- 
cient training  in  dietetics  to  meet  this  new  demand,  but, 
with  the  rapid  progress  this  phase  of  medical  treatment 
is  making,  the  education  of  the  nurses,  and  eventually  the 
whole  community,  will  naturally  follow. 

While  we  are  doing  much  in  the  way  of  individual 
treatment,  it  has  not  yet  been  universally  adopted,  and, 
in  order  that  there  may  be  some  sort  of  a  guide  at 
Lakeside  Hospital  for  the  nurses  in  the  diet  kitchen  who 
prepare  the  food  for  the  special  diets,  and  for  the  nurses 
who  do  the  serving  in  the  wards,  a  set  of  diets  was  pre- 
pared for  several  of  the  more  common  diseases.  At  the 
request  of  the  writer  Dr.  Christy  furnished  the  concise 
but  comprehensive  accompanying  statements,  which  add 
very  greatly  to  the  helpfulness  of  these  lists. 

For  gastric  and  duodenal  ulcers,  some  of  the  physi- 
cians use  the  regular  Lenhartz  diet  with  no  variations. 
When  the  patient  is  ready  for  a  comparatively  full  diet, 
he  is  served  from  the  list  prepared  for  hyperacidity  (list 


Special  Diets  in  Disease.  73 

No.  2).  If  the  trouble  should  be  low  acidity,  the  low 
protein  list  is  used  (list  No.  3) .  In  other  cases  the  Sippey 
diet  is  used. 

Post-Operative    Care    of    Gastric    and    Duodenal   Ulcer 
Cases — Modified  Sippey  Treatment  for  Gastric  Ulcer. 

FIRST  WEEK. 

Rectal  tap  of  sodium  bicarbonate  and  glucose,  4  per- 
cent each. 

First  day  (post-operative) — ^Water  in  small  amounts 
by  mouth  and  by  hypodermoclysis  as  ordered  by  house 

staff. 

Second  day — Water  by  mouth  as  ordered. 

Third  day  (if  routine  treatment  is  ordered) — 1/2  ounce 
each  of  milk  and  cream  every  hour  from  6  a.  m.  to  8  p.  m. 
Each  morning  before  feedings  are  begun  give  1  dram  of 
bismuth  subcarbonate  in  small  amount  (1  or  2  ounces)  in 
warm  water.  Midway  between  feedings  give  5  grains 
each  of  calcined  magnesia,  sodium  bicarbonate,  and  bis- 
muth subcarbonate  in  1/2  ounce  of  warm  water.  If  no 
discomfort  at  end  of  third  day  and  patient  does  well,  then 

Fourth  day — 1  ounce  each  of  milk  and  cream  every 
hour.  Continue  powders. 

Fifth  day— IV2  ounces  each  of  milk  and  cream  every 
hour.    Continue  powders. 

Sixth  day—Soft  egg  added  to  milk  in  the  morning  and 
afternoon. 

Seventh  day— Soft  egg ;  2  if  desired.  Add  3  ounces  of 
well-cooked  cereal  at  noon.  Then  gradually  add  eggs  and 
cereal  to  other  feedings  until  2  or  3  eggs  and  two  or  three 
feedings  of  3  ounces  of  well-cooked  cereal  are  taken. 

Total  milk  at  any  one  feeding  should  not  exceed  6 
ounces.  Maximum  of  feeding  should  not  exceed  4  eggs 
and  four  feedings  of  cereal  in  addition  to  milk  and  cream. 


74  Modern  Dietetics. 

Cereals — rice  (well  cooked),  oatmeal,  farina,  and  cream 
of  wheat. 

At  the  end  of  ten  days  a  small  quantity  of  stewed  fruits, 
jellies,  or  seedless  marmalades,  adding  cream  soups  of  all 
kinds,  puree  of  potato,  toasted  crackers,  and  milk  toast. 

SECOND  WEEK. 

Increase  the  length  of  time  between  feedings,  so  that 
at  the  beginning  of  the  third  week  food  is  taken  every 
two  hours.  Total  bulk  should  not  be  more  than  8  ounces. 
Eat  at  least  five  times  per  day  for  several  months. 

For  one  year  or  more  keep  on  this  diet — milk,  cream, 
cereals,  soft  eggs,  vegetable  purees,  cream  soups,  bread 
and  butter,  and  meats  when  desired. 

For  cardiac  cases  Dubois'  milk  diet  (list  No.  4)  and 
the  cardiac  diet  (list  No.  5)  are  used. 

The  treatment  of  typhoid  has  been  somewhat  revolu- 
tionized in  recent  years  by  the  use  of  a  high  calorie  diet. 
A  milk  diet  in  typhoid  is  illogical,  as  it  does  not  furnish 
enough  protein  to  cover  the  loss.  The  extent  to  which  the 
digestion  is  impaired  is  only  about  10  percent,  so  there  is 
no  objection  to  meat  in  moderate  quantities,  but  it  should 
be  finely  minced.  The  high  calorie  typhoid  diet  (list 
No.  6)  was  designed  to  give  approximately  3,000  calories 
daily.  If  enough  calories  cannot  be  given  by  the  intake 
of  the  plain  food  materials,  lactose  may  be  added  to  the 
milk  to  somewhat  increase  the  number.  Since  the  feed- 
ings must  be  given  frequently,  it  is  quite  desirable  to  have 
a  variety.  This  list  not  only  avoids  the  monotony  of 
broths  and  milk,  but  permits  of  the  nourishing  cream 
soups,  custards,  etc.,  being  interchanged  with  the  more 
refreshing  ices,  fruit  juices,  etc.,  which  will  induce  the 
patient  to  eat  more  than  he  might  otherwise.  Fresh 
pineapple  juice  has  been  found  to  be  very  valuable,  not 
only  in  these  cases  of  high  temperature,  but  in  anorexia. 


Special  Diets  in  Disease.  75 

anemia,  gastritis,  and  with  the  convalescent  diet  (list 
No.  6). 

The  treatment  of  diabetes  is  almost  entirely  dietetic, 
but  it  must  necessarily  vary  w^ith  the  individual.  Much 
more  attention  has  been  given  to  this  disease  the  past  few 
years,  and  the  treatment  of  it  has  undergone  a  decided 
change  within  the  past  two  years.  Formerly  it  was 
thought  that,  in  addition  to  the  consideration  given  to 
glycosuria,  it  was  important  to  maintain  nutrition  and 
prevent  loss  of  body  weight.  Dr.  Allen,  of  the  Rockefeller 
Institute  for  Medical  Research,  thinks  that  this  is  not  the 
case,  stating  that  "the  reduction  of  weight  is  in  itself 
beneficial  to  the  diabetic  condition  and  serves  to  spare 
the  weakened  function  and  increase  tolerance."  He  gave 
a  very  comprehensive  statement  of  his  theory  in  the 
American  Journul  of  the  Medical  Sciences  of  October, 
1915.  This  treatment  is  being  adopted  by  many  medical 
men  with  very  good  results.  In  the  treatment  of  diabetes 
it  is  important  not  only  to  remove  glycosuria  and  acidosis, 
but  the  patient  should  be  followed  up.  He  should  be 
educated  to  control  his  own  condition  and  make  his  own 
tests;  then,  when  advice  is  needed,  he  can  get  it  before 
too  much  damage  has  been  done.  The  diabetic  diet  (list 
No.  7)  includes  a  general  classification  of  food  materials 
which  may  be  safely  used  in  any  form  of  treatment,  and 
is  designed  for  use  of  the  patient  after  he  has  left  the 
hospital ;  this  same  diet  may  be  used  for  obesity. 

The  diet  lists  for  nephritis  (No.  8),  purin-free  (No. 
9),  high  iron  content  (No.  10),  and  benzidin  (No.  11), 
are  self-explanatory. 

No  special  diet  for  tuberculosis  is  advisable,  the  point 
to  observe  being  always  to  furnish  a  nourishing  diet  that 
will  not  overtax  the  digestion.  The  patient  can  utilize  fat 
in  large  quantities,  as  he  should  be  out  of  doors  a  great 
deal,  even  if  he  is  not  exercising  very  much.    Milk  and 


76 


Modern  Dietetics. 


eggs  are  essential,  of  course,  but  the  tendency  to  use  them 
to  excess  is  rather  strong,  and  this  is  apt  to  give  the 
patient  a  feeling  of  revulsion  toward  them  after  having 
consumed  large  quantities  for  any  considerable  length  of 
time.  One  quart  daily  is  a  liberal  allowance  of  milk,  and 
a  part  of  it  may  be  served  in  cream  soups,  custards,  or 
other  forms,  as  well  as  a  beverage.  Three  eggs  daily  are 
plenty  and  as  many  as  the  majority  of  patients  will  take. 

In  addition  to  these  diet  lists,  some  of  which  are  used  in 
the  surgical  as  well  as  in  the  medical  wards  of  Lakeside 
Hospital,  there  is  the  test  breakfast,  which  is  in  general 
use — tea  and  bread. 

The  liquid  diet,  soft  with  care,  and  convalescent  are  in 
use  throughout  the  hospital  as  preliminaries  to  the  full 
hospital  diet. 

Too  great  emphasis  cannot  be  placed  on  the  statement 
that  no  diet  should  be  followed  implicitly,  that  preparing 
and  cooking  food  require  skill,  and  that  the  methods  em- 
ployed affect  the  results  to  a  very  appreciable  degree. 


No.  1 

..    Diet  for  Gastric  Ulcers — ^Lenhartz  Diet 

• 

Day 

Eggs,* 
amount 

Sugar, 
grams 

MUk,* 
c.c. 

Raw 

beef, 

chopped, 

grams 

Milk  and 

rice, 

grams 

Zwieback 
or 

crackers, 
amount 

Raw 

ham, 

chopped, 

grams 

Butter, 
grams 

Calo- 
ries, 
amount 

1 

2 

3 

4 

2 
3 

4 
5 
6 

7 
8 
8 
8 
8 
8 
8 
8 
8 

■  ■  20' 
20 
30 
30 
40 
40 
50 
50 
50 
50 
50 
50 
50 

200 

300 

400 

500 

600 

700 

800 

900 

1,000 

1,000 

1,000 

1,000 

1,000 

1,000 

200 

420 

637 

777 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

35 
70 
70 
70 
70 
70 
70 
70 
70 
70 

955 

100 
100 
200 

300 
300 
300 
300 
300 
300 

1,135 

1,588 

1 

2 
2 
3 
3 
4 
5 

1,721 

2,138 

50 
50 
50 
50 
50 

20 
40 
40 
40 
40 

2,478 
2,941 
2,941 
2,941 
2,941 

♦Serve  milk  and  eggs  as  egg-nog;  set  glass  in  bowl  of  ice;  to  be  sipped  by 
spoonfuls. 


Special  Diets  in  Disease.  77 

This  diet  is  used  primarily  in  gastric  and  duodenal 
ulcers,  the  idea  being  to  give  as  little  food  as  possible  to 
the  patient,  but  enough  to  keep  up  caloric  value  and 
thereby  to  lessen  irritation. 

To  be  served  at  8  and  11  a.  m.  and  2,  5,  and  8  p.  m. 

From  first  to  seventh  day,  inclusive,  all  eggs  are  beaten. 
From  seventh  to  fourteenth  day,  inclusive,  half  are 
beaten  and  half  are  cooked.  Third  week,  soft  with  care 
diet.     Fourth  week,  soft  diet.     Fifth  week,  house  diet. 

Absolute  quiet  for  four  weeks.  Bowels  not  to  be  moved 
for  first  week,  not  often  for  three  weeks;  then  small 
glycerin  or  warm  water  enema.  Out  of  bed  twenty- 
eighth  day.    Home  sixth  to  tenth  week. 

No.  2.    Diet  for  Hyperacidity  (Salt  Poor). 

This  diet,  which  is  high  in  protein,  is  indicated  in 
hyperacidity.  HCL  is  used  up  entirely  in  protein  diges- 
tion. It  is  salt  poor  because  salt  enhances  production  of 
HCL.  To  be  used  for  gastroenterostomy  and  duodenal 
ulcer  when  patient  is  put  on  house  diet. 

Roast  meats,  steak,  bacon,  chicken,  fish,  chops. 

Eggs  in  any  form. 

Cereals ;  rice  as  a  vegetable  or  cereal. 

Legumes,  green  vegetables,  salads  (except  those  made 
of  fresh  fruits),  and  tomato. 

Breads,  of  coarse  flour. 

All  fruits,  except  lemons,  grapefruit,  and  gooseberries. 
Fruits  given  to  patients  in  this  condition  are  better  if 
cooked. 

Soups  of  all  kinds  may  be  given  sparingly,  except 
tomato. 

Desserts — Cream  desserts,  custards,  gelatins,  soft 
puddings. 

Milk  may  be  given  between  meals.    No  coffee  or  tea. 

Olive  oil  may  be  taken  in  large  quantities. 


78 


Modern  Dietetics. 


No.  3.     Diet  for  Subacidity  (Low  Protein,  Salt  High). 

This  diet,  as  its  name  implies,  is  for  low  acidity  in  the 
stomach.  Since  protein  digestion  depends  primarily  on 
hydrochloric  acid,  and  as  this  is  low,  it  will  be  evident 
that  protein  will  not  be  well  cared  for.  Salt  should  be 
high,  as  it  is  a  forerunner  in  the  production  of  hydro- 
chloric acid. 

Bread,  butter,  and  sugar. 

Cereal — Once  daily. 

Eggs  or  fish — Once  daily. 

Noodles  or  macaroni. 

Cream  soup. 

Legumes,  potato,  green  vegetables. 

Fruit,  dessert. 

Coffee  or  tea. 


No.  4.     Dubois*  Milk  Diet. 

This  diet  is  used  primarily  in  the  cardiac  cases  where 
there  is  extreme  decompensation.  The  idea  is  to  limit 
fluid  intake  and  preclude  solid  food  from  an  already  over- 
congested  and  inactive  intestinal  tract. 


Day 

7  a.  m. 

9  a.  m. 

11  a.  m. 

1  p.  m. 

3  p.  m. 

5  p.  m. 

7  p.  m. 

9  p.  m. 

ounces 

ounces 

ounces 

ounces 

ounces 

ounces 

ounces 

ounces 

1 

3 

3 

3 

3 

3 

3 

3 

3 

2 

4K 

4^ 

4K 

4^ 

4H 

4M 

4H 

4^ 

3 

6 

6 

6 

6 

6 

6 

6 

6 

4 

9 

9 

9 

9 

9 

9 

9 

9 

5 

12 

6 

6 

9 

6 

6 

9 

6 

6 

12 

6 

6 

9 

6 

6 

9 

6 

*7 

On  fifth  day — brown  bread  added  to  diet,  with  honey  or 
butter.  G.  A.  M.  lime  juice,  2  ounces  in  water;  4  ounces  if 
ordered.  No  other  fluid  unless  ordered. 


♦Light  diet  with  milk  in  afternoon. 


Special  Diets  in  Disease.  79 

No.  5.     Diet  for  Cardiac  Disease. 

This  diet  is  designed  to  meet  the  needs  of  chronic  heart 
cases,  because  of  low  fluid  content  and  the  fact  that  it  is 
an  easily  assimilable  diet.  Since  we  have  great  conges- 
tion of  the  alimentary  tract,  digestion  proceeds  slowly. 
It  is  also  a  diet  of  food  materials  which  will  not  readily 
ferment.  Fermentation  and  distention  are  contraindi- 
cated  because  of  the  added  embarrassment  to  the  heart 
action  and  circulation. 

Water — In  limited  amounts.  To  be  specified  by  the 
ward  man. 

Ice — In  small  quantities  in  severe  cases. 

Milk — 8  ounces  three  times  daily.  Sipped  slowly  with 
meals. 

Vegetables — All  green  vegetables.  Cereals  and  starchy 
vegetables  are  restricted.  No  fermenting  vegetables,  such 
as  those  of  the  cabbage  family  or  dried  legumes. 

Bread — In  small  amounts. 

Meats — Roast  beef,  steak,  lamb,  chicken,  fish.  No  in- 
ternal meats,  such  as  liver,  sweetbreads,  heart,  etc.  No 
raw,  smoked,  cured,  or  rare  meats. 

No  eggs. 

Fats — Butter,  cream,  olive  oil,  mayonnaise. 

Desserts — Junket,  custards,  jellies,  ices,  sherbets, 
stewed  fruits,  oranges,  grapefruit. 

No.  6.     Diet  for  High-Calorie  Typhoid. 

As  the  name  implies,  this  gives  as  great  a  number  of 
calories  of  food  as  possible  to  a  typhoid  patient,  and  takes 
away  the  undesirable  features  of  a  solid  diet,  which 
would  enhance  perforation  and  irritation  to  an  ulcerated 
and  inflamed  bowel. 

Milk — Hot  or  cold;  modified  with  lime  water,  soda 
water,  apollinaris,  or  vichy;  or  in  the  form  of  koumiss, 
buttermilk,  whey,  junket,  or  peptonized  milk. 


80  Modern  Dietetics. 

Tea  or  coffee. 

Soups — Cream  soups,  or  purees  with  all  vegetables 
strained;  clear  soups;  broths;  oyster  stew,  with  oysters 
removed. 

Gruels — Of  any  cereal  not  containing  very  high  per- 
centage of  cellulose,  and  strained  through  fine  strainer. 

Albumin  drinks — Water,  plain  or  flavored  with  fruit 
juices;  milk,  plain  or  flavored  with  fruit  juices. 

Ice  cream  or  ices,  without  solid  particles  of  fruit  or 
nuts. 

Eggs — Soft  cooked,  raw,  or  in  the  form  of  egg-nog  or 
custard. 

Meat — Finely  minced  chicken  or  beef,  or  scraped  beef. 

Crackers — Soaked  in  milk  or  broth. 

Soft  puddings,  gelatin,  apple  sauce  strained. 

No.  7.    Diet  for  Diabetes. 

Carbohydrate  food  may  be  given  to  chronic  cases  in 
small  amounts  at  the  direction  of  the  ward  man.  This 
diet  is  so-called  carbohydrate-free,  for  in  the  case  of 
diabetes  the  patient  is  unable  to  assimilate  carbohydrate 
food  except  in  small  amounts,  and  consequently  any 
quantity  taken  above  his  tolerance  will  immediately  pass 
into  his  blood,  causing  high  sugar  content.  Under  these 
conditions  the  kidneys  will  be  unable  to  hold  it  back 
longer,  and  it  will  filter  through  into  the  urine,  giving 
rise  to  the  condition  we  know  as  glycosuria,  the  chief 
manifestation  of  diabetes. 

Soups — All  stock  soups  and  bouillons. 

Meats — Meats  (except  internal  organs,  such  as  liver 
and  sweetbreads),  poultry,  and  fish  of  all  kinds  (not  pre- 
pared with  flour)  may  be  used  in  comparatively  small 
amounts. 

Eggs  in  any  form. 

Vegetables — Asparagus,   artichokes,   cauliflower,   cab- 


Special  Diets  in  Disease.  81 

bage,  brussels  sprouts,  sauerkraut,  onions,  young  green 
beans,  tomatoes,  celery,  lettuce,  watercress,  endive,  chic- 
ory, spinach,  pickles,  olives,  mushrooms,  eggplant,  Swiss 
chard  (either  leaves  or  stalks). 

Fruit — Gooseberries,  rhubarb,  grapefruit. 

Nuts  of  all  kinds,  except  chestnuts. 

Bread — Bran  muffins  (see  recipe). 

Desserts — Gelatin  (sweetened  with  saccharin),  fla- 
vored with  coffee;  cream,  nuts,  sherry,  brandy,  custards 
made  of  cream  and  sweetened  with  saccharin. 

Clotted  cream — Ice  cream  sweetened  with  saccharin. 

Cheese— All  kinds  used  abundantly. 

Beverages — Tea,  coffee,  lemonade  (sweetened  with 
saccharin) . 

Fats— Should  be  used  plentifully  in  cooking;   salad 

dressings,  cream. 

No.  8.    Diet  for  Nephritis. 

This  diet  is  low  in  most  extractives,  as  these  substances 
are  high  in  purin  bodies,  which  are  eliminated  poorly  by 
the  kidneys.  It  is  also  low  in  salt,  as  salt  is  eliminated 
poorly,  and  the  edema  of  nephritis  is  largely  dependent 
on  the  high  salt  content  in  the  tissues  from  the  fact  that  a 
diseased  kidney  eliminates  salt  poorly.  The  fruit  acids, 
being  also  undesirable  to  inflamed  kidneys,  are  either 
left  out  if  they  contain  high  amounts  of  the  acids,  or  the 
fruit  is  cooked,  which,  in  a  measure,  overcomes  that 
undesirable  feature. 

Milk  in  any  form  and  foods  made  from  milk  in  limited 
quantity,  buttermilk,  koumiss,  whey,  junket,  peptonized 
milk,  cream,  cocoa. 

Cream  soups  of  all  kinds,  except  cream  of  beans  and 
cream  of  peas. 

Fruits  of  all  kinds,  stewed,  except  lemons  and  grape- 
fruit. 


82  Modern  Dietetics. 

Vegetables — Potatoes,  squash,  carrots,  beets,  cabbage, 
cauliflower,  brussels  sprouts,  lettuce,  celery,  artichokes, 
tomatoes,  spinach,  sauerkraut,  asparagus,  onions. 

Fats  of  all  kinds,  butter,  cream,  olive  oil  (in  salad 
dressing) . 

White  bread  and  cereals  in  moderate  amounts,  toast, 
zwieback,  crackers. 

No.  9.    Purin-Free  Diet. 

This  is  given  to  gouty  patients  because  the  purins  are 
the  forerunners  of  uric  acid,  and,  as  the  disease  is  a  de- 
posit of  sodium  urate  or  a  salt  of  uric  acid  in  the  tendons 
and  joints,  it  will  be  evident  that  anything  that  favors 
uric  acid  formation  should  be  low  in  this  diet.  Purins 
should  be  low  because  they  are  precursors  of  uric  acid. 
(See  Sherman  on  Purin  Diets.) 

ALLOWED. 

White  bread,  crackers. 
Rice,  potatoes,  macaroni. 

Apples,  grapes,  dates,  figs,  raisins,  honey,  nuts,  oils,  all 
forms  of  fat. 

Milk  and  cheese  in  moderate  amounts,  eggs. 

PROHIBITED. 

Rich  meats,  soups,  sauces,  and  gravies ;  game,  salt  fish, 
salted  or  cured  meats,  sausage,  lobster,  all  foods  highly 
seasoned  or  pickled. 

Rich  pastries,  freshly  made  breads. 

Tomatoes,  cucumbers,  mushrooms,  rhubarb,  asparagus, 
legumes. 

Tea  or  coffee,  alcohol  in  any  form. 

This  diet  is  suitable  for  exophthalmic  goiter,  with  the 
addition  of  chicken  and  fish,  salt  being  added  and  acids 
avoided. 


Special  Diets  in  Disease.  83 

No.  10.    Diet  Containing  High  Iron  Content. 

This  diet  is  indicated  in  secondary  anemia  and  chlo- 
rosis, where  the  iron  content  of  the  tissues  is  low  and 
consequently  there  is  a  low  hemoglobin  estimation  in 
blood. 

Liver,  beef  steak,  roast  beef. 

Eggs. 

Oatmeal,  cereals  made  from  wheat. 

Bread — White,  rye,  whole  wheat,  graham,  bran. 

Beans — All  kinds,  peas.  l*,.*.-v-^s  \ 

Peanuts,  almonds,  walnuts,  spinach,  prunes,  raisins, 
dates,  figs,  apples. 

The  following  contain  less  than  1  percent  of  iron: 
lettuce,  celery,  corn,  cornmeal,  cabbage,  asparagus,  pota- 
toes, honey,  grapes,  cocoa. 

No.  11.    Benzidin  Test  Diet. 

Milk,  crackers,  rice. 

This  is  an  iron-free  diet.  The  idea  is  to  free  the  ali- 
mentary tract  of  any  added  iron  and  then  test  the  stool 
for  iron.  If  iron  is  present,  and  it  is  a  fact  that  none  was 
given  in  the  food,  it  must  come  from  one  source — the 
hemoglobin  of  the  blood.  It  is  taken  as  a  positive  test  for 
bleeding  into  the  intestinal  tract  and  as  evidence  of  an 
ulcer.  Patients  should  be  watched  to  make  certain  that 
they  eat  nothing  but  those  articles  listed. 

No.  12.    Liquid  Diet. 

Milk — Sweet,  modified  with  lime  water  or  barley  water, 
or  in  the  form  of  buttermilk,  whey,  or  junket. 
Broths,  gruels  strained,  beef  juice,  beef  tea. 
Cocoa  (hot  or  iced),  tea  (hot  or  iced),  coffee. 
Fruit  beverages — Lemonade,  orangeade,  grape  juice. 
Barley  water  or  rice  water. 
Albumin  drinks — Milk,  water. 


84  Modern  Dietetics. 

Cream  soups. 
Egg-nog. 

Frozen  creams  or  ices. 

Include  one  quart  of  milk  and  three  eggs  daily.  To  be 
given  in  eight  feedings. 

No.  13.    Light  Soft  Diet  (in  Addition  to  "Liquid  Diet"). 

Dry  or  milk  toast. 

Eggs,  soft  boiled  or  poached. 

Custards,  gelatins. 

Oranges. 

Apple  sauce,  and  prunes,  strained. 

Cereals — Arrowroot,  tapioca,  or  rice,  in  the  form  of 
cereal  or  dessert. 

Six  servings  daily.  Never  serve  cereal  and  eggs  at  the 
same  meal. 

No.  14.     Convalescent  Diet  (in  Addition  to  Light  Soft 

Diet). 

Grapefruit  (all  fruits  to  be  strained,  and  all  vegetables 
strained  or  mashed  when  advisable) . 

Vegetables — Peas,  carrots,  asparagus,  spinach;  celery, 
cooked;  tomato,  cooked;  potato,  baked  or  mashed;  rice, 
squash. 

Fish,  chicken,  steak,  lamb  chops,  scraped  meat  balls, 
scraped  meat  sandwiches. 

Constipation  (Dr.  H.  FeU). 

Habit. — Go  to  the  toilet  every  morning  immediately 
after  breakfast.  Go,  whether  there  is  a  desire  to  have  a 
bowel  movement  or  not.  Go  to  the  toilet  when  the  desire 
comes,  but  try  to  have  the  desire  after  breakfast.  If 
movement  does  not  occur,  assist  by  deep  breathing — do 
not  strain. 

Exercise. — Walking,  running,  outdoor  games,  dancing. 


Special  Diets  in  Disease.  85 

gymnastic  exercises  should  be  done  each  day.  Take  at 
least  twenty  deep  breaths  night  and  morning.  A  good 
form  of  mild  exercise  may  be  carried  out  as  follows: 
Grasp  with  both  hands  a  pole  or  broomstick;  then,  with 
arms  stretched  out,  bend  the  body  forward,  with  the  feet 
together,  then  backward,  and  to  the  right  and  to  the  left. 
Perform  these  movements  alternately — say,  twenty  times 
night  and  morning. 

Diet. — Drink  eight  glasses  of  water  daily,  a  glass  or 
two  of  cold  water  on  rising  and  at  bedtime.  Eat  freely 
of  butter,  cream,  olive  oil,  and  fruits. 

Breakfast. — Cereal,  with  milk  or  cream  and  sugar 
(oatmeal,  cornmeal,  hominy,  shredded  wheat,  boiled  rice, 
cream  of  wheat) .  Graham  bread,  com  bread,  rye  bread, 
bran  bread,  butter,  molasses,  honey,  jellies,  preserves, 
eggs  or  fish,  bacon,  weak  coffee  with  milk  or  cream, 
malted  milk,  buttermilk.  Fruits,  raw  or  stewed,  at  the 
end  of  the  meal. 

Lunch. — Little  cold  meat  or  egg  sandwiches,  potatoes, 
vegetables,  bread  as  above,  buttermilk  or  malted  milk, 
fruit  or  fruit  juices. 

Dinner. — Vegetable  soup,  bread  and  butter  as  above, 
fish  or  meat,  potatoes,  vegetables  (lettuce,  spinach,  car- 
rots, parsnips,  oyster  plant,  cauliflower,  squash,  tomatoes, 
beets,  onions,  cucumbers,  cabbage).  Fruits,  jellies,  but- 
termilk or  malted  milk,  or  weak  tea  and  coffee  with  milk 
or  cream. 

Avoid.— The  drinking  of  milk,  white  bread  unless  well- 
buttered  and  thoroughly  chewed,  and  much  meat. 

Chew. — All  food  to  small  bits. 

Deep  Breathing.— Take  twenty  deep  breaths  night  and 
morning. 

BRAN  BREAD. 

Should  be  eaten  in  place  of  white  bread. 


86  Modern  Dietetics. 

Take  2  cups  bran  flour,  2  cups  wheat  flour,  1  cup  sour 
milk,  4  tablespoons  molasses,  2  teaspoons  soda,  a  little 
salt.    Bake  in  muffin  pans,  one  to  be  eaten  with  each  meal. 


CHAPTER  XIV. 
CLASSES  OF  PEOPLE  TO  BE  FED. 

SURGICAL  PATIENTS — MATERNITY  CASES — PRIVATE  PA- 
TIENTS— FEEDING  INTERNS  AND  NURSES — HOSPITAL 
HELP — MAKING  MENUS — FOOD  CARTS  AND  CONTAIN- 
ERS— PANTRIES — DIET  TRAINING  FOR  NURSES — THE 
COMMISSARY. 

Feeding  Surgical  Patients. 

The  diet  is  not  so  vital  a  part  of  the  treatment  of  sur- 
gical and  maternity  cases  as  it  is  of  medical  cases,  but 
indirectly  it  is  an  important  phase  of  their  treatment  in 
the  hospital.  As  a  rule,  these  patients  have  good  appe- 
tites and  probably  unimpaired  digestion,  and  the  need  is 
not  so  great  for  exercising  care  to  prevent  them  from 
eating  the  wrong  foods;  after  the  first  few  days  pre- 
caution may  be  needed  to  prevent  their  eating  too  much. 
Frequently  these  patients,  especially  surgical  cases,  want 
a  great  deal  to  eat,  or  perhaps  want  to  eat  often,  because 
that  is  practically  the  only  break  in  the  monotony  of  the 
day.  They  should  be  urged  to  spend  a  long  time  at  their 
meals— to  eat  slowly  and  masticate  thoroughly,  which 
lessens  the  danger  of  overtaxing  the  digestive  organs 
and  at  the  same  time  gives  the  patient  a  more  satisfied 
feeling.  Eating  bulky  foods,  such  as  fibrous  vegetables 
and  fruits,  and  large  bowls  of  soup  will  also  help  in  the 
same  way.  Both  of  these  measures  will  aid  in  preventing 
constipation,  which  might  otherwise  result  from  overeat- 
ing and  inactivity.  The  patient  should  be  made  to  un- 
derstand that  a  serious  derangement  of  nutrition  may 
be  brought  about  by  clogging  up  the  system  with  more 
food  than  the  body  can  take  care  of. 

87 


88  Modern  Dietetics. 

It  is  common  for  patients — paying  patients — to  com- 
ment on  the  fact  that  they  eat  much  more  than  they  have 
ever  done  at  home.  It  is  evident  that  many  of  the  pri- 
vate room  patients  in  the  larger  modern  hospitals  are 
overfed,  as  they  are  served  an  adequate  menu  by  the 
house  and  are  given  many  extras  by  their  friends.  If 
they  fail  to  consume  all  of  this  food,  their  condition  is 
considered  by  these  friends  more  or  less  serious,  and  they 
bring  a  greater  variety  of  things  in  order  to  tempt  the 
appetite  of  the  patient. 

There  are  many  patients,  however,  who,  for  one  reason 
or  another,  do  not  eat  a  sufficient  amount  of  food.  In 
some  instances  this  may  be  due  to  a  prejudice  against 
institutional  food  or  cooking,  but  in  more  instances  it  may 
be  due  to  the  length  of  time  the  patients  remain  in  the 
hospital.  Their  inactivity  leads  to  a  loss  of  appetite  and 
dissatisfaction  with  the  food,  and  efforts  should  be  made 
to  induce  them  to  take  sufficient  nourishment  in  some  at- 
tractive form.  An  effective  method  is  to  serve  some  new 
dish,  or  to  serve  food  in  a  different  manner  from  the  usual 
custom — to  combine  the  needed  food  materials  in  novel 
ways,  and  to  give  the  meal  in  the  nature  of  a  surprise. 
Even  well  people  enjoy  the  pleasures  of  anticipation  of 
food,  and  this  is  far  more  true  of  the  sick.  Almost  in- 
variably patients  enjoy  a  meal  more  if  there  are  elements 
of  expectation  and  surprise  connected  with  it,  which  is 
one  reason  for  not  having  routine  menus — a  particular 
thing  on  every  Monday,  another  on  every  Tuesday,  and 
so  on.  Neither  is  it  well  to  discuss  the  menu  with  the 
patient;  an  observant  nurse  can  soon  learn  the  food  a 
patient  will  not  eat,  and  avoid  serving  the  things  which 
are  distasteful  to  him. 

This  phase  brings  up  the  question  of  "special  orders" 
for  patients — to  just  what  extent  shall  the  whims  of  a 
patient  be  gratified  and  just  how  much  latitude  can  be 


Classes  of  People  to  Be  Fed.  89 

given  his  wishes?  Not  only  should  the  line  be  drawn, 
but  there  should  be  a  complete  disregard  of  two  pre- 
vailing reasons  given  for  special  orders  in  many  of  our 
hospitals — namely,  "My  patient  is  paying  seventy-five 
or  one  hundred  dollars  (as  the  case  may  be)  per  week, 
and  is  thereby  entitled  to  these  little  extras,"  and  "The 
doctor  said  he  could  have  anything  he  wished."  These 
demands  are  being  met  in  each  hospital  according  to  its 
conditions  and  resources,  but  they  are  entitled  to  no  con- 
sideration anywhere.  This  state  of  affairs  shows  plainly 
another  need  of  cooperation  between  the  physician  and 
the  dietitian. 

The  Whims  of  Private  Patients. 

At  Lakeside  Hospital  the  special  orders  have  been 
reduced  to  a  minimum  in  the  private  and  semi-private 
wards  by  preparing  a  menu  which  gives  a  rather  wide 
variety  of  food.  For  example,  for  breakfast  there  is  a 
choice  of  fruits,  two  cooked  and  two  "prepared"  cereals, 
bacon  and  eggs,  toast,  rolls,  and  at  all  meals  any  of  the 
common  beverages  may  be  chosen.  For  dinner  there  is 
a  choice  of  a  clear  soup  or  a  cream  soup ;  a  roast  meat  or 
steak,  or  eggs  in  any  form;  a  baked  potato  or  one  pre- 
pared in  some  other  way ;  two  other  vegetables ;  a  salad ; 
a  frozen  dessert,  or  some  other  kind.  The  menu  is  varied 
as  much  as  possible,  so  that  there  shall  be  no  monotony 
in  the  diet.  If  the  patient  still  desires  something  which 
requires  extra  preparation,  an  extra  charge  is  made  for  it. 
It  is  not  often  that  a  patient  cannot  select  enough  from 
this  menu  to  give  him  a  satisfactory  meal,  even  though 
there  are  some  things  being  served  for  which  he  does 
not  care. 

The  number  of  servings  required  in  each  ward  is 
reported  to  the  dietitian,  and  she  posts  it  on  a  bulletin 
board  in  the  kitchen,  so  that  the  cooks  know  just  how 


90  Modern  Dietetics. 

much  is  to  be  prepared.  This  type  of  menu  makes  a  little 
more  work  for  the  dietitian  and  the  kitchen  force,  but 
not  a  great  deal  more  than  would  be  necessary  in  the 
preparation  of  many  special  orders.  It  has  the  advantage 
of  giving  every  patient  the  same  privilege,  while  by  the 
other  method  the  number  of  "extras"  a  patient  gets  de- 
pends about  as  much  on  the  kind  of  a  nurse  he  has  as  it 
does  on  his  actual  requirements. 

Feeding  Maternity  Patients. 

As  a  rule,  maternity  patients  have  very  good  appetites, 
and  with  them,  too,  there  is  sometimes  a  tendency  to 
overeat.  This  desire  for  large  servings,  or  frequent 
serving,  has  been  explained  occasionally  by  the  statement 
that  they  must  eat  a  great  deal  because  they  are  eating 
for  two  people,  though  just  how  or  why  this  should  be 
the  case  the  writer  has  never  been  able  to  learn. 

There  has  been  a  theory  in  the  past  that  a  mother 
should  not  eat  acid  foods  or  foods  with  a  strong  flavor 
during  the  early  period  of  the  child's  nursing,  but  it 
has  been  very  satisfactorily  proved  that  the  child  is  not 
affected  by  the  diet  of  the  mother  so  long  as  she  confines 
herself  to  the  things  which  for  her  are  easily  digested, 
and  there  need  be  no  change  in  her  method  of  eating, 
provided  her  powers  of  assimilation  are  good. 

Feeding  the  Interns  and  Nurses. 

Is  it  making  too  strong  a  statement  to  say  that  proba- 
bly nowhere  in  the  world  will  one  find  a  class  of  people 
more  critical  of  their  food  or  more  difficult  to  please  than 
nurses  and  interns  ?  There  are  some  very  good  psycho- 
logical explanations  of  this,  but  the  critical  attitude  of 
these  people  remains  much  the  same,  and  the  condition 
seems  to  be  pretty  general  in  hospitals  throughout  the 
country.    These  persons  almost  invariably  enjoy  the  food 


Classes  of  People  to  Be  Fed.  91 

when  they  first  enter  the  hospital,  but  sooner  or  later  add 
their  complaints  to  those  of  the  earlier  comers.  Un- 
doubtedly there  are  some  instances  where  complaint  is 
justified,  but  usually  the  food  in  the  hospitals  is  as  good 
in  quality  and  as  great  in  variety  as  is  to  be  found  in  the 
homes  of  people  in  a  similar  walk  of  life. 

Much  depends,  of  course,  on  the  resources  of  hospitals, 
but  it  must  be  remembered  that  the  food  is  cooked  in 
large  quantities,  and  must  be  cooked  long  enough  before 
serving  to  allow  time  for  it  to  be  transferred  to  carriers 
of  some  sort,  taken  some  distance,  and  made  ready  to 
serve  to  a  number  of  people,  and  it  is  not  possible  to  give 
to  it  the  same  characteristic  flavors  that  may  be  acquired 
in  a  home  where  practically  no  time  elapses  between  the 
cooking  and  serving  processes.  Then,  again,  where  there 
are  so  many  tastes  to  which  to  cater,  only  neutral  season- 
ings and  mild  flavors  can  be  used. 

Hospital  people  work  hard  and  meet  great  demands  on 
their  physical  force,  and  should  have  food  which  will  re- 
build tissue  and  furnish  energy.  Their  work  is  indoors, 
however,  so  their  power  of  oxidation  is  not  so  great.  The 
nature  of  their  work  and  their  environment  unfit  them 
for  digestion  of  concentrated  or  heavy  foods,  or  of  much 
fat,  and  for  this  reason  meat  three  times  daily,  though 
that  is  one  of  the  most  common  demands,  is  not  desirable, 
and  rich  puddings  or  pastry  should  be  given  sparingly. 
The  mode  of  life  of  the  hospital  resident  is  conducive  to 
constipation,  so  that  fruits,  green  vegetables,  and  salads 
should  be  served  as  much  as  possible.  Now  that  there 
are  good  brands  of  dried,  preserved,  and  canned  fruits 
which  may  be  made  most  palatable,  fruit  is  not  beyond 
the  reach  of  any  hospital.  Apples,  bananas,  dates,  and 
figs  are  not  expensive,  and  make  splendid  combinations 
with  cereal  for  breakfast,  or  may  be  used  in  salads,  or  in 
desserts  for  luncheon.    Apples  and  bananas,  when  baked 


92  Modern  Dietetics. 

or  fried,  may  serve  in  place  of  a  vegetable,  or  may  be 
inexpensively  made  into  fritters.  Some  years  oranges 
and  grapefruit  are  so  moderate  in  price  that  the  fruit 
question  is  an  easy  one. 

Cereals,  including  rice,  macaroni,  and  spaghetti,  are 
staple  hospital  food  materials,  but  are  generally  scorned. 
They  are,  nevertheless,  desirable  substitutes  for  meat, 
not  only  because  they  cost  less  money,  but  because  they 
have  much  food  value,  are  easily  digested,  and  furnish 
bulk,  which  indoor  workers  need  in  their  diet.  When 
well  cooked,  they  can  be  made  very  palatable,  and  are 
susceptible  of  so  many  combinations  with  other  food 
materials  that  they  give  much  variety  to  the  menu. 

Cream  soups,  purees,  and  chowders  have  high  nutritive 
value,  and  are  most  appetizing  luncheon  dishes.  The 
lighter  forms  of  meat,  like  bacon,  liver,  stuffed  calf 
heart,  hot  or  pickled  tongue ;  cheese  in  an  almost  endless 
variety  of  forms  (such  as  fondue,  creamed  cheese  on 
toast,  cottage  cheese  salad,  or  cheese  on  potato,  rice,  or 
macaroni) ;  macaroni  and  fritters,  already  mentioned ; 
and  the  salads  which  lend  themselves  to  so  many  ways 
of  serving,  may  all  be  utilized  to  good  advantage  for  the 
lighter  meal  of  the  day  and  are  not  too  expensive  for  the 
hospital  of  limited  means. 

It  is  better,  if  possible,  to  serve  luncheon  at  noon  and 
dinner  at  night.  The  nurses  are  more  fit  for  the  after- 
noon work  if  not  digesting  a  heavy  meal  while  trying  to 
concentrate  on  their  duties.  Dinner,  being  the  main  meal 
of  the  day,  is  the  one  over  which  we  like  to  linger  just 
a  little,  and  it  is  highly  desirable  that  the  food  be  so  well 
prepared  and  served  that  it  will  not  intrude  itself  on  the 
conversation,  as  it  will  undoubtedly  do  if  it  is  not  pleasing. 

The  nurses  and  doctors  are  entitled  to  the  best  that  the 
hospital  can  afford  to  give  them,  and  it  is  but  small  re- 
turn for  their  best  service  which  they  give  to  the  hospi- 


Classes  of  People  to  Be  Fed.  93 

tal.  They  should  have  plenty  of  food  of  good  quality, 
cooked  and  served  as  well  as  can  be  done  in  the  hospital. 
They,  as  well  as  the  patients,  base  as  much  of  their  satis- 
faction with  the  hospital  and  their  life  in  it  on  the  food 
as  on  any  other  feature?  Only  when  people  are  happy 
and  contented  can  they  do  their  best  work.  We  may  not 
in  our  time  reach  the  point  of  feeding  the  people  in  a 
hospital  to  their  satisfaction  or  to  our  own  satisfaction, 
but  we  should  do  the  best  with  all  material  available; 
and  even  though  we  must  use  the  same  things  repeatedly, 
they  can  be  used  in  enough  different  ways  to  prevent 
monotony.  It  is,  indeed,  disheartening  to  look  ahead  for 
a  year  and  know  that  one  is  to  have  the  same  thing  every 
morning,  or  every  Monday  or  Wednesday,  during  the 
whole  stretch  of  time ;  nor  is  there  any  economy  in  that 
method,  as  it  leaves  scant  opportunity  to  utilize  stock 
on  hand.  There  will  always  be  food  in  the  ice  box  or 
store  room  which  cannot  be  held  until  the  prescribed 
day  for  it  to  be  used. 

Feeding  the  Hospital  Help. 

Then  there  is  the  problem  of  feeding  the  "help"  of  the 
hospital.  The  chief  difficulty  in  feeding  these  people  is 
convincing  them  that  the  authorities  are  interested  in 
their  meals  as  well  as  in  the  other  food  of  the  hospital. 
When  they  know  that  the  selection  and  preparation  of 
their  food  is  given  care,  and  that  they  are  not  receiving 
only  that  which  is  unavailable  for  the  other  people,  they 
are  not  likely  to  make  complaints.  It  is  a  great  mistake 
to  allow  much  to  be  left  over  from  other  parts  of  the 
house  and  to  use  it  up  on  the  help.  In  the  first  place,  this 
is  extravagance ;  in  the  second  place,  it  gives  the  help  the 
impression  that  they  are  being  fed  on  "scraps." 

The  help  must  have  plain,  substantial  food  and  plenty 
of  it.     They  do  not  care  for  "fancy  dishes,"  and,  as  a 


94  Modern  Dietetics. 

rule,  do  not  demand  as  much  variety  as  the  other  inmates 
of  the  hospital.  This  does  not  mean  that  they  may  be 
given  the  same  things  again  and  again  day  after  day,  but 
a  reasonable  amount  of  variety  is  usually  satisfactory. 

Making  Out  the  Menus. 

In  the  making  of  menus  there  are  many  things  to  be 
considered  which,  to  an  outsider,  may  seem  of  minor  im- 
portance, but  which  count  for  much  in  getting  out  meals. 
Everyone  recognizes  the  fact  that  the  buying  must  be 
governed  by  the  funds  available  for  the  commissary  de- 
partment, but  not  everyone  is  familiar  with  vast  differ- 
ences in  markets,  their  methods  of  filling  orders,  and 
their  facilities  for  delivering.  The  length  of  time  to  be 
allowed  in  advance  of  making  out  menus  depends  almost 
entirely  on  the  market's  delivery  system.  The  number 
of  employees  in  the  kitchen  and  their  competency  modi- 
fies the  menu  very  much,  as  does  also  the  kind  of  equip- 
ment in  the  kitchen.  Naturally,  the  better  manned  a 
kitchen  is  the  more  effectively  can  the  work  be  done,  and 
it  is  no  economy  to  employ  an  unskilled  cook  at  a  low 
salary.  The  best  results  cannot  be  obtained  when  the 
kitchen  force  is  so  limited  that  everyone  is  working  up 
to  the  limit  of  his  capacity  all  of  the  time.  In  no  other 
part  of  the  house  are  the  hours  as  long  as  in  the  kitchen, 
or  so  rigid  in  that  the  work  must  be  done  by  a  certain 
time  every  day,  with  no  possibility  of  leaving  some  of  it 
over  for  another  day;  yet  it  is  very  seldom  that  the 
kitchen  department  is  given  the  same  consideration  and 
its  system  or  regulation  shown  the  same  respect  as  is 
accorded  other  parts  of  the  house. 

Food  Carts. 

Another  problem  which  seems  almost  to  have  baffled 
solution  thus  far  is  the  conveying  of  food  from  the 


Classes  of  People  to  Be  Fed.  95 

kitchen  to  the  various  serving  pantries  in  such  a  manner 
that  the  hot  things  will  be  hot  and  the  cold  things  will 
remain  cold,  and  everything  be  in  proper  condition  when 
it  reaches  its  destination. 

There  are  food  carts  with  devices  for  keeping  food  hot 
by  means  of  hot  water  compartments  or  other  heating 
devices,  but  these  do  not  provide  for  foods  being  kept 
cold ;  besides,  they  are  very  heavy,  even  when  empty,  and 
when  loaded  with  food  are  often  too  much  for  one  person 
to  manage.  The  German  Hospital  in  New  York  city  has  a 
cart  with  compartments  for  different  foods  and  for  the 
necessary  dishes,  which  is  taken  into  the  ward,  and,  in- 
stead of  serving  from  a  pantry,  the  serving  is  done  from 
the  cart  with  a  minimum  handling  of  materials,  with  no 
waste  of  time  in  the  ward.  This  arrangement,  however, 
necessitates  a  cart  for  every  ward  and  a  very  efficient 
elevator  service,  and  there  will  be  some  complications  in 
getting  these  carts  filled  and  out  of  the  kitchen  unless  the 
arrangement  of  the  kitchen  space  is  well  adapted  to  the 
use  of  the  large  number  of  carts. 

If  a  cart  should  be  built  with  compartments  for  both 
hot  and  cold  foods,  with  insulated  partitions  or  shelves 
between,  simple  in  construction  and  with  few  complicated 
parts  to  get  out  of  order,  and  light  enough  to  be  drawn  by 
one  man,  it  would  fill  the  needs.  A  cart  which  has  these 
insulated  shelves  and  compartments  for  hot  and  cold 
food  is  manufactured,  but  it  is  built  only  in  connection 
with  and  for  use  on  an  electric  motor  truck  made  by  the 
manufacturers  of  the  car.  The  price  is  $1,200,  so  that  its 
use  would  not  be  practicable  unless  it  could  be  employed 
for  delivery  in  all  departments,  as  not  many  hospitals 
would  feel  justified  in  spending  that  sum  for  the  delivery 
of  nothing  but  kitchen  supplies.  Food  containers  of 
heavy  pressed  tin,  or  copper,  or  aluminum,  with  insets  of 
the  same  material  and  devices  for  surrounding  these  in- 


96  Modern  Dietetics. 

sets  with  hot  water,  are  perhaps  as  satisfactory  for  keep- 
ing food  warm  as  anything  in  general  use.  These  con- 
tainers, when  sent  out  in  closed  carts,  will  keep  food  hot 
for  a  reasonable  length  of  time,  but  they  are  disastrous 
to  gelatins  or  salads  that  happen  to  be  sent  out  at  the 
same  time,  as  is  usually  necessary. 

Food  Containers. 

The  sooner  we  can  eliminate  copper  from  our  kitchens, 
the  better  it  will  be  for  our  cooking.  It  is  expensive,  not 
only  because  of  the  initial  cost,  but  the  frequent  retinning 
it  requires  adds  very  considerably  to  its  expense.  Be- 
cause of  the  short  time  the  retinning  remains  safe,  as  well 
as  of  the  cost  of  the  process  and  the  time  required  for  the 
utensils  to  be  out  of  use,  one  can  almost  always  find  cop- 
per being  used  which  is  not  sanitary  if  a  very  great 
supply  of  copper  is  used  at  all  in  the  kitchen. 

Aluminum  is  no  more  expensive  in  the  end,  and  has 
the  advantage  of  remaining  in  good  condition  indefinitely, 
provided,  of  course,  that  a  good  grade  of  aluminum  is 
bought  and  that  it  receives  reasonably  careful  treatment. 

The  food  containers  above  mentioned  made  of  alumi- 
num in  sizes  corresponding  to  the  number  of  patients  to 
be  fed  in  the  ward  meet  practically  every  need.  An  out- 
side container,  or  box,  is  made  large  enough  to  hold  insets 
for  meat,  potato,  and  one  other  vegetable.  A  rack  which 
stands  1  to  li/^  inches  above  the  bottom  of  the  box  serves 
as  a  platform  upon  which  these  insets  rest.  Hot  water 
is  put  into  the  box,  which  does  not  come  above  the  rack. 
This  hot  water  not  only  keeps  the  food  from  becoming 
cold  while  being  carried  to  its  destination,  but  it  also 
serves  as  a  hot  water  bath  in  which  the  food  is  kept  hot 
during  serving.  The  box  may  be  placed  over  the  gas 
flame  in  the  serving  kitchen  on  the  ward,  and  there  is  no 
danger  of  the  food  burning  or  becoming  dry.    In  addition 


Classes  of  People  to  Be  Fed.  97 

to  their  other  advantages,  these  boxes  are  easily  kept 
clean  and  are  attractive  in  appearance. 

These  food  containers  are  better  in  the  serving  pantries 
than  a  steam  table,  provided  there  is  stove  space  enough 
to  permit  of  their  being  placed  over  a  flame.  Time  is  lost 
in  transferring  the  food  to  the  steam  table  insets,  and  the 
extra  handling  detracts  from  the  appearance  of  the  food. 
Serving  pantries  are  usually  small,  and  the  heat  from  the 
steam  table  makes  the  room  very  uncomfortable  for  those 
doing  the  serving ;  then,  too,  the  warm,  moist  atmosphere 
of  the  room  makes  it  impossible  to  allow  the  salads  and 
cold  desserts  to  remain  in  the  room  even  during  the  serv- 
ing time,  and  not  many  serving  rooms  have  sufficient  ice 
box  space  to  accommodate  these  things.  It  would  be  very 
convenient  to  have  one  section  of  the  refrigerator  built 
with  many  shelves  just  far  enough  apart  to  permit  dishes 
filled  with  salad  or  dessert  ready  to  serve  to  be  placed  on 
these  shelves  and  taken  out  only  as  needed.  All  too  many 
ice  boxes  do  not  have  enough  shelf  space,  but  do  have  too 
much  waste  space  between  the  shelves. 

Serving  Pantries. 

Serving  pantries  should  be  provided  with  shelves  or 
racks  with  space  enough  to  permit  all  trays  to  be  set  with 
the  necessary  dishes  before  serving  begins.  The  more 
expeditiously  the  serving  can  be  done,  the  more  palatable 
will  be  the  food.  With  the  trays  all  set  and  the  cold  things 
all  served  and  in  the  ice  box,  the  process  of  getting  out 
the  trays  can  be  made  a  very  simple  one.  With  some  pa- 
tients the  appearance  of  the  tray  may  determine  whether 
the  food  will  be  eaten.  It  is  a  common  error  to  serve  too 
much  on  a  tray,  which  is  repulsive  to  some  patients,  and 
the  majority  of  them  are  not  in  a  condition  to  digest 
large  amounts  of  food.  It  is  far  better  to  give  dainty 
servings,  with  the  understanding  that  more  may  be  had 


98  Modern  Dietetics. 

if  desired.  The  question  of  economy  is  no  small  one  when 
two  hundred  or  three  hundred  people  are  being  served 
and  the  large  majority  of  them  are  served  more  than  they 
can  eat.  This  same  question  of  economy  applies  to  the 
preparation  of  egg-nogs  and  orangeades  and  the  heating 
of  broths  and  gruels.  The  amount  needed  should  be  meas- 
ured out  before  preparing,  leaving  none  to  be  thrown  into 
the  sink,  as  is  too  frequently  done.  Such  things  as  these 
are  the  cause  of  the  divergence  of  opinion  between  the 
kitchen  and  the  ward  with  regard  to  quantities  needed. 

Diet  Training  for  Nurses. 

The  nurse's  training  in  dietetics  comes  into  use  when 
she  does  the  serving  in  the  wards,  and  it  is  unfortunate 
if  she  has  not  had  her  diet  kitchen  training  before  she 
does  any  serving.  This  training  enables  her  to  give  much 
better  service  to  the  patients  and  to  the  hospital,  and  it  is 
quite  essential  where  there  are  many  special  diets  to  be 
served. 

It  is  only  by  keeping  in  close  touch  with  the  various 
wards  and  knowing  the  needs  of  each  that  the  dieti- 
tian can  give  the  best  service  to  the  patients  with  a 
minimum  of  work  in  the  serving  pantries,  and  without 
overtaxing  the  working  capacity  of  the  kitchen.  In  order 
to  keep  expenses  as  they  should  be,  she  must  have  full 
knowledge  of  the  store  rooms  and  the  markets. 

Though  there  may  be  a  very  rigid  system  regulating 
requisitions  for  supplies  in  other  parts  of  the  house,  the 
general  impression  in  the  average  hospital  is  that  the 
kitchen  is  managed  on  the  short-order  restaurant  plan 
and  that  anything  desired  should  be  obtainable  at  any 
time  desired.  The  recognition  of  the  commissary  depart- 
ment as  an  organized  part  of  the  whole  scheme,  with 
which  almost  every  other  department  is  more  or  less  inti- 
mately connected,  is  so  recent  that  we  hardly  realize  that 


Classes  of  People  to  Be  Fed.  99 

it  exists.  With  this  recognition  is  coming  a  demand  that 
the  department  be  placed  on  a  higher  plane,  and  a  higher 
standard  is  being  set  for  the  person  in  charge,  whether  he 
be  cook  or  dietitian. 


CHAPTER  XV. 
FEEDING  VARIOUS  INSTITUTIONS. 

CATERING  TO  THE  TUBERCULOUS — FEEDING  THE  CHILDREN 
— THE  INSANE  HAVE  THEIR  OWN  PROBLEM — BUYING  FOR 
AND  FEEDING  ELEEMOSYNARY  INSTITUTIONS — FEEDING 
PRIVATE  SANATORIUM S — HELP  IN  THE  KITCHEN — DIE- 
TETICS OF  THE  FUTURE. 

Professor  Mendel,  of  Yale,  says,  "Among  the  modern 
sciences  that  bear  on  the  every-day  life  of  men,  there  are 
few  which  appear  to  meet  with  so  little  popular  recogni- 
tion as  does  the  science  of  nutrition."  This  is  very  true 
in  general,  and  more  conspicuously  true  in  our  hospitals 
and  other  institutions  where,  in  other  departments,  scien- 
tific work  is  not  only  recognized,  but  regarded  as  neces- 
sary. The  large  majority  of  our  hospitals  have  until 
recently  given  very  little  thought,  efltort,  or  money  to  the 
planning  or  equipping  of  their  commissary  departments, 
and  even  now  it  is  only  a  few  that  have  done  so.  Visitors, 
or  those  who  for  any  reason  wish  to  see  the  hospital  in  its 
entirety,  or  to  observe  the  scheme  of  working  in  its  sev- 
eral departments,  are  very  seldom  shown  the  kitchens. 
There  is  usually  plenty  of  reason  for  being  ashamed  of 
the  kitchens,  but  there  is  not  a  good  reason  why  this  state 
of  affairs  should  exist. 

Institutions  are  known  by  the  manner  in  which  they 
prepare  and  serve  food,  just  as  individuals  are  known  by 
their  reputations  for  efficiency  and  morality.  It  is  sur- 
prising that  there  are  as  good  results  in  the  feeding  of 
hospitals  as  are  obtained  when  the  commissary  depart- 
ment receives  such  indifferent  attention.  No  one  ques- 
tions the  importance  of  good  food  in  a  hospital,  but  very 
few  have  any  conception  of  the  difficulties  to  be  over- 

100 


Feeding  Various  Institutions.  101 

come  in  serving  good  food.  The  difficulty  of  cooking  with 
a  defective  stove  or  oven  when  feeding  a  large  number  of 
people  at  a  specified  hour,  three  times  every  day,  cannot 
be  imagined  by  one  who  has  never  been  through  the 
experience.  Psychologists  tell  us  that  persons  employed 
about  furnaces,  large  ranges,  or  places  where  they  work 
in  a  high  temperature,  "are  likely  to  become  unstable  in 
their  disposition  and  intemperate  in  their  habits."  When, 
in  addition  to  this,  they  are  subjected  to  the  annoyances 
of  improper  utensils  or  inadequate  equipment,  how  much 
greater  must  be  the  effect  on  their  disposition  and  habits, 
and,  incidentally,  on  their  efficiency  ?  Food  which  is  over- 
cooked, undercooked,  or  unevenly  cooked  is  not  palatable, 
and  much  of  it  is  not  easy  of  digestion,  and  this  fact  may 
result  in  great  waste,  which  in  time  amounts  to  more  than 
the  price  of  a  stove,  not  to  mention  the  dissatisfaction 
that  sort  of  food  creates. 

Adequate  refrigerator  space  is  very  necessary  to  keep 
food  at  its  best,  and  all  the  more  necessary  where  such 
large  quantities  are  used  that  a  long  time  is  required  for 
its  preparation,  which  is  done  in  a  room  at  a  compara- 
tively high  temperature.  Artificial  refrigeration  has 
reached  such  a  stage  of  perfection  that  even  stnall  hospi- 
tals find  its  use  advantageous.  Good  equipment  and  intel- 
ligent cooks  are  essential  in  the  proper  feeding  of  every 
institution,  whether  it  is  large  or  small,  of  limited  means 
or  well  endowed,  though  the  kind  of  food,  methods  of 
storing,  and  the  cooking  and  serving  are  extremely  vari- 
able in  different  institutions  for  people  of  the  same  class. 

In  a  state  or  county  institution  the  supplies  are  bought 
by  a  purchasing  committee,  usually  at  a  per  capita  rate, 
for  three  months  or  six  months  at  a  time.  As  every- 
thing is  bought  in  such  large  quantities,  it  can  usually  be 
bought  at  lower  prices  and  there  is  little  excuse  for  pur- 
chasing goods  of  poor  quality.    Since  they  are  to  be  kept 


102  Modern  Dietetics. 

for  some  time,  it  is  not  good  policy  to  buy  anything  of 
poor  quality.  A  large,  dry,  well-lighted,  well-ventilated 
store  room  should  be  provided  for  the  supplies.  While 
this  method  of  buying  makes  it  more  difficult  to  have  a 
great  variety  on  the  menu,  it  affords  splendid  opportunity 
for  systematic  control  of  the  whole  food  problem;  but 
if  it  is  not  well  controlled,  there  is  great  opportunity  for 
waste.  More  or  less  waste  is  unavoidable  from  vegetable 
decay,  shrinkage  in  the  store  room  due  to  the  large 
amount  which  must  be  kept  on  hand,  or  carelessness  in 
the  kitchen  and  store  room.  The  majority  of  the  people 
working  in  the  kitchens  of  our  institutions  become  so 
accustomed  to  seeing  great  quantities  of  food  that  they  do 
not  have  the  proper  respect  for  small  quantities,  and  to 
them  a  quart  of  milk  or  a  pound  of  meat  is  a  trifling  mat- 
ter. This  is  a  common  attitude  of  nurses  toward  hospital 
property,  and  it  is  even  more  common  in  the  kitchen  force. 

In  the  report  of  the  dietary  studies  carried  on  in  the 
institutions  of  New  York  city  it  was  stated  that  the 
kitchen  force  became  interested  in  the  experiments,  and 
a  definite  effort  toward  improvement  was  especially 
noticeable  in  cooking  and  caring  for  supplies  in  both  the 
kitchens  and  dining  rooms ;  the  influence  of  this  interest 
on  the  chef  and  cook  being  most  beneficial.  This  result 
can  be  attained  in  any  institution,  and  is  particularly 
desirable  in  the  smaller  hospitals  whose  means  are 
limited. 

In  feeding  the  insane  it  is  frequently  necessary  to  regu- 
late the  amount  of  food  allowed  individuals,  as  otherwise 
some  patients  would  eat  more  and  others  less  than  they 
need.  It  may  not  be  necessary  to  regulate  the  amount  of 
food  eaten  by  the  sane,  but  in  many  instances  it  is  advisa- 
ble. The  caloric  method  furnishes  a  pretty  accurate  esti- 
mate of  the  requirements  of  the  average  body,  but  it  does 
not  deal  with  the  requirements  of  the  individual.     The 


Feeding  Varioiis  Institutions.  103 

averages  furnish,  however,  a  very  reliable  guide  to  the 
metabolist.  There  is  a  vast  deal  of  work  necessary  in 
introducing  this  method,  but,  once  established,  it  is 
comparatively  simple. 

A  great  many  institutions  of  all  kinds  are  estimating 
per  capita  cost.  This  is  an  excellent  plan  for  obtaining 
general  information  and  for  comparison,  but  it  cannot  be 
taken  as  a  standard.  Such  common  food  stuffs  as  butter, 
eggs,  and  meat  vary  so  greatly  in  price  from  year  to 
year  in  different  sections  of  the  country  that  the  same 
amounts  might  not  be  equally  feasible  in  the  East  and  in 
the  West,  and  in  one  year  a  given  sum  might  not  buy 
nearly  as  much  as  it  would  in  another.  It  is  possible  to 
have  a  generous  per  capita  cost  and  at  the  same  time  to 
feed  the  people  in  a  very  unsatisfactory  manner  because 
of  waste,  lack  of  proper  vision  of  food  stuffs,  injudicious 
serving,  or  fluctuating  population. 

The  per  capita  ration  is  a  very  satisfactory  method  of 
estimating  the  quantities  of  food  stuff  required.  The 
ration  differs  according  to  the  people  who  are  being  fed, 
and  the  allowance  for  the  patients  would  not  be  the  same 
as  for  the  people  working,  but  the  menus  are  never  the 
same  for  the  two  classes  of  people,  so  that  it  is  easy  to 
have  the  two  estimates.  The  allowance  for  one  hospital 
might  not  be  at  all  satisfactory  in  another,  and  therefore 
a  table  of  quantities  could  not  be  used  generally,  any 
more  than  one  of  per  capita  cost  could.  It  is,  however, 
the  most  accurate  system  with  which  the  writer  has  had 
experience  in  providing  quantities,  and  there  is  less  waste 
and  fewer  left-over  things  of  which  to  take  care. 

These  are  a  few  of  the  general  problems  that  apply  to 
any  kitchen  in  which  the  food  must  be  prepared  in 
large  quantities,  and  there  are,  of  course,  many  specific 
conditions  to  be  met  in  each  individual  commissary 
department. 


104  Modern  Dietetics. 

Feeding  the  Tuberculous. 

In  tuberculosis  hospitals  the  food  should  be  furnished 
in  smaller  quantities  and  given  more  frequently.  The 
patients  must  have  not  only  enough  food  to  nourish  them 
in  the  normal  way,  but  there  must  be  enough  to  repair 
the  damage  done  by  the  ravages  of  the  disease.  The  food 
must  be  wholesome  and  the  food  materials  in  good  condi- 
tion, and  no  green  or  overripe  fruits  or  vegetables  should 
be  used.  The  milk  should  be  clean  and  free  from  contami- 
nation of  any  sort  up  to  the  minute  the  last  of  it  is  used, 
and  should  test  not  less  than  3.4  or  3.5  percent  of  fat. 
Milk  and  eggs  are  used  for  tuberculous  people  in  com- 
paratively large  quantities,  and  it  is  especially  desirable 
that  they  be  carefully  selected  and  cared  for.  No  mat- 
ter how  good  milk  and  eggs  are,  the  patients  are  apt  to 
tire  of  them ;  and  it  is  not  necessary  that  they  constitute 
the  chief  part  of  the  diet,  though  they  must  be  used  gen- 
erously because  of  their  high  nutritive  value  and  ease  of 
digestion.  Other  foods  may  be  used  freely  to  supplement 
the  milk  and  eggs;  green  and  fresh  vegetables  cooked 
with  plenty  of  butter  or  cream  sauce,  or  served  with  oil, 
furnish  mineral  salts,  fat,  and  the  bulk  which  is  helpful 
in  preventing  constipation.  Cereals  well  cooked  and 
served  with  milk,  cream,  or  butter  are  an  excellent  food 
for  tuberculous  patients.  Unpolished  rice  might  well  be 
used  much  more  than  it  is ;  it  has  a  nutty  flavor  which 
makes  it  more  palatable  than  the  polished  rice,  and  is 
therefore  more  acceptable,  and  it  has  greater  food  value. 
The  acids  of  fruit  are  stimulating  to  the  digestion  and  the 
sugars  add  to  the  caloric  value  of  the  diet.  All  food 
should  be  simple — no  rich  puddings  or  pastries,  highly 
seasoned  food,  or  combinations  of  sauces,  wines,  etc.  It 
should  be  cooked  in  a  manner  that  will  make  it  easily 
digested  and  assimilated,  in  order  that  the  digestive  or- 
gans may  not  be  taxed  and  that  the  body  may  not  lose 


Feeding  Various  Institutions.  105 

any  of  the  food  value.  The  tuberculous  patient  should 
not  eat  large  quantities  at  a  time,  as  his  comparative  in- 
activity does  not  allow  him  to  get  the  greatest  good  from 
his  food  if  taken  in  this  way  and  his  digestive  organs  are 
apt  to  suffer.  Light  lunches,  or  some  form  of  nourish- 
ment in  the  middle  of  the  forenoon  and  afternoon,  are 
much  better  for  him.  In  the  hospital  where  insufficient 
funds  or  lack  of  help  makes  these  luncheons  impossible, 
a  glass  of  egg-nog,  a  bowl  of  bread  and  milk,  a  cup  of 
cocoa,  a  dish  of  junket,  a  plate  of  dates  or  figs,  or  raisins, 
may  be  served  at  small  expenditure  of  time  and  money, 
and  any  of  these  is  a  helpful  addition  to  the  patient's 
diet. 

Feeding  the  Children. 

Children's  hospitals  need  a  dietary  similar  to  the  one 
just  outlined,  except  that  vegetables  and  fruits  should  not 
be  served  in  the  form  of  salads.  For  the  younger  chil- 
dren all  vegetables  and  fruits  should  be  made  into  purees, 
strained,  and  meats  should  be  chopped ;  but  the  older  chil- 
dren should  be  given  things  which  require  chewing  and 
should  be  taught  to  masticate  them  thoroughly.  As  in 
the  tuberculosis  diet,  the  food  should  be  simple,  plain, 
and  thoroughly  cooked ;  milk  and  eggs  are  necessary,  and 
even  more  of  the  cereals,  gruels,  cream  soups,  etc.,  are 
desirable.  With  the  children,  too,  serving  smaller  quan- 
ties  and  serving  more  frequently  is  essential. 

The  question  of  infant  feeding  is  usually  one  that  is 
decided  by  the  physician  in  charge,  and  the  preparations 
are  apt  to  be  according  to  formulas  furnished  by  him. 
Milk  may  be  modified  in  many  ways,  with  definite  propor- 
tions of  fat,  sugar,  and  protein  according  to  formula,  or 
with  lime  water  or  barley  water  in  order  to  prevent  the 
clotting  of  the  casein  into  curds  that  are  difficult  for  the 
digestive  juices  to  break  up.    Barley  has  glutinous  prop- 


106  Modern  Dietetics. 

erties,  which  make  it  especially  good  for  modifying  milk. 
Chymogen  milk  is  milk  that  is  sterilized  and  then  cooled 
to  a  temperature  of  about  104°  or  105°  F.,  and  to  which 
chymogen  powder  is  added  to  coagulate  the  casein;  the 
curd  is  then  beaten  until  the  clots  have  all  disappeared. 
Care  must,  however,  be  taken  not  to  heat  the  milk  above 
98°  F.  before  feeding,  or  the  finely  divided  particles  will 
again  form  a  clot.  Chymogen  action  is  much  the  same 
as  the  digestive  step  in  the  stomach  caused  by  the  action 
of  rennin,  and  the  separation  of  the  curd  by  beating 
merely  helps  the  action  a  little  more.  Peptonized  milk 
and  eiweissmilch  are  other  forms  much  used  in  infant 
feeding. 

Feeding  the  Insane. 

The  hospital  for  the  insane  has  a  somewhat  different 
problem.  While  the  food  of  the  insane  must  be  plain  and 
have  a  high  nutritive  value,  there  are  some  complications 
in  serving  not  to  be  found  in  other  places.  The  need  for 
well-prepared  and  attractively  served  food  is  just  as  great 
here  as  elsewhere.  It  is  difficult  with  many  of  these  pa- 
tients to  persuade  them  to  masticate  their  food  properly, 
and  epileptics  and  the  demented  are  inclined  to  bolt  their 
food.  Supervision  of  the  dining  room  is  almost  impera- 
tive to  overcome  this  difficulty,  as  well  as  to  prevent 
wasteful  serving,  and  to  see  that  some  are  not  overfed. 
As  a  rule,  the  depressed  and  oversensitive  eat  too  little. 
It  is  important  that  the  dining  room  be  w^ell  ventilated 
at  the  meal  hour  and  that  no  disconcerting  sounds  or  dis- 
agreeable odors  reach  the  patients,  as  there  are  nearly 
always  some  who  are  likely  to  be  affected  by  these  ex- 
ternal conditions  more  than  rational  persons.  They  may 
have  delusions  about  their  food  which  are  difficult  to 
overcome  and  which  cause  them  to  refuse  to  eat.  There 
seems  to  be  as  yet  no  very  satisfactory  solution  of  the 
problem  of  feeding  the  demented  who  cannot  be  trusted 


Feeding  Various  Institutions.  107 

with  knives  and  forks.  All  too  frequently  their  food  is 
put  into  any  sort  of  container  that  the  hospital  finds  con- 
venient and  of  little  value  if  destroyed.  Some  infirm 
patients,  because  of  their  inability  to  masticate,  may  be 
able  to  eat  only  vegetables  and  fruits  that  have  been 
strained,  meats  that  have  been  chopped,  and  soups  and 
other  soft  things.  Their  diet  must  necessarily  be  mo- 
notonous, and  there  is  all  the  greater  need  that  it  should 
be  well  cooked. 

Feeding  Charity  Hospitals. 

In  the  state,  county,  or  municipal  institutions,  where 
the  supplies  are  bought  by  a  committee  not  directly  asso- 
ciated with  the  hospital,  and  are  to  last  for  a  period  of 
several  months,  it  is  helpful,  provided  the  population  is 
not  too  variable,  to  use  the  per  capita  ration  as  a  basis 
in  making  out  the  order.  In  these  hospitals  it  is  impera- 
tive that  there  should  be  intelligent  and  judicious  super- 
vision of  the  commissary  department,  as  otherwise, 
toward  the  end  of  the  period  for  which  supplies  are  pur- 
chased, there  will  be  a  shortage  of  stock.  Supplies  should 
be  given  out  only  by  requisition,  and  there  should  be  a 
definite  system  of  drawing  on  them,  so  they  may  be  used 
with  approximate  uniformity. 

A  very  satisfactory  method  of  attending  to  this  matter 
of  supplies  was  followed  at  Oak  Forest  Infirmary,  Chi- 
cago. Menus  were  made  out  for  three  weeks,  allowing 
for  as  great  a  variety  as  possible  during  that  period. 
These  were  repeated,  and  any  desirable  change  was  made 
from  time  to  time  in  minor  things,  such  as  fresh  vegeta- 
bles and  fruits,  as  they  came  in  from  the  farm  or  were 
ordered.  In  this  way  perishable  articles  could  be  used 
as  they  were  delivered,  but  meats  and  other  things  for 
which  time  was  required  in  ordering  could  be  kept  in  sup- 
ply as  needed.  The  butcher  had  a  copy  of  the  standard 
menu,  knew  whether  the  menu  for  the  first,  second,  or 


108  Modern  Dietetics. 

third  week  was  being  used,  and  could  order  his  stock 
accordingly.  This  avoided  a  repetition  of  any  one  article 
on  the  same  day  of  each  week,  and  the  supplies  in  the 
store  room  were  drawn  on  according  to  the  quantities 
available,  thus  making  things  come  out  even. 

In  institutions  of  this  kind  the  fare  must  necessarily 
be  less  expensive  and  of  less  variety  than  in  private 
institutions,  as  in  the  latter  there  is  especially  great  need 
for  a  cook  who  can  cook  well  and  introduce  variety  in 
the  way  of  seasonings  or  combinations  of  common  food 
materials. 

Feeding  the  Private  Sanatorium. 

In  the  private  sanatorium  and  hospital  the  need  for  a 
heavy,  nourishing  diet  is  not  ordinarily  so  great  as  the 
need  of  an  attractive,  appetizing  one.  While  many  of 
the  patients  must  be  "built  up"  and  must  have  nutritive 
food,  they  require  greater  variety,  dainty  service,  and 
generally  less  in  quantity.  Proper  combinations  of  food, 
served,  as  far  as  is  possible  in  a  hospital,  in  a  novel  and 
original  manner,  are  most  important.  This  does  not 
mean  that  better  cooks  should  be  employed,  for  it  is  just 
as  essential  that  the  plainer  foods  should  be  as  well 
cooked  as  the  more  delicate  ones,  but  it  means  a  greater 
number  of  employees.  A  small  touch  in  the  way  of  gar- 
nishing, or  a  tiny  bit  of  an  appetizing  sauce  added  to  a 
vegetable,  salad,  or  dessert,  may  represent  an  addition 
of  considerable  work  in  the  preparation  of  that  particular 
dish.  High-class  restaurants  and  hotels  make  much  of 
these  extras,  and  the  public  has  been  taught  to  expect 
them,  but  these  places  provide  every  sort  of  machine  or 
device  for  the  preparation  of  fancy  things,  while  in  the 
majority  of  hospitals  it  requires  all  one's  power  of  persua- 
sion to  get  the  necessary  utensils  and  equipment  for  such 
work.    There  is  a  strong  tendency  to  overdo  garnishing 


Feeding  Various  Institutions.  109 

and  decorating,  and  often  the  efforts  to  lend  a  pleasing 
note  have  completely  overshadowed  the  preparation  of 
the  article  itself.  To  a  sensitive  person  this  is  most  dis- 
pleasing, and  private  sanatoriums  entertain  many  sensi- 
tive and  even  supersensitive  people.  Besides  the  extrava- 
gance of  this  habit,  it  sometimes  leads  to  the  substitu- 
tion of  a  less  nutritive  food  material  for  one  of  greater 
value.  ;For  example,  a  large  leaf  of  lettuce  may  be  used 
with  a  small  serving  of  salad ;  the  lettuce  has  much  less 
food  value  than  the  majority  of  salads  served  on  it,  and 
the  large  green  leaf,  being  out  of  proportion  to  the  other 
part  of  the  serving,  detracts  from  the  daintiness  of  its 
appearance. 

In  order  to  serve  its  principal  purpose,  a  sanatorium 
must  be  more  or  less  remote  from  large  cities,  and  conse- 
quently it  cannot  have  access  to  large  markets.  Unless, 
therefore,  the  sanatorium  has  its  own  source  of  supply, 
one's  ingenuity  is  severely  taxed  to  provide  the  desired 
variety.  As,  however,  the  serving  is  done  in  a  dining 
room,  the  situation  is  not  so  serious  as  it  might  be  other- 
wise. One  can  often  combine  small  amounts  of  meat,  fish, 
or  poultry  into  chowders,  omelets,  or  casserole  dishes ;  or, 
with  vegetables,  make  them  into  ragouts ;  and,  with  the 
addition  of  white  sauce,  cream  soups  and  bisques  may 
be  made  from  them.  Vegetables  and  fruits  may  be  used 
in  fritters,  and  salads  and  souffles  can  be  prepared  in 
a  large  number  of  combinations.  These  things  are  pos- 
sible where  the  service  is  almost  directly  from  the  kitchen 
and  the  serving  is  at  a  table. 

Help  in  the  Sanatorium  Kitchen. 

In  the  sanatorium  kitchen  the  problem  of  help  is  differ- 
ent from  that  of  the  kitchens  of  other  institutions,  as 
either  the  civil  service  requirements  or  inmate  help,  or 
both,  complicate  matters.    There  are  often  times  when 


110  Modern  Dietetics. 

the  force  is  weakened  by  the  absence  of  some  of  the  num- 
ber, but  the  meals  must  go  out  promptly,  and  the  meal 
hour  in  all  large  institutions  extends  over  a  considerable 
length  of  time,  so  that  there  is  little  spare  time  between 
meals.  Under  civil  service  rules  no  employee  may  be 
made  to  work  an  extra  hour,  no  matter  how  great  the 
need.  The  work  in  the  kitchen  begins  at  half -past  4  or  5 
o'clock  in  the  morning,  and  may  not  end  until  7  o'clock 
or  later  in  the  evening,  so  that  it  is  very  necessary  that 
enough  people  are  employed  to  allow  for  relief. 

The  question  of  inmate  help  will  not  be  considered  here 
from  the  standpoint  of  the  institution  or  from  the  stand- 
point of  other  departments,  but  from  the  viewpoint  of 
the  kitchen.  Inmate  help  is  not  competent,  of  course, 
and,  with  the  exception  of  the  preparation  of  vegetables 
and  fruits  or  doing  some  part  of  the  cleaning,  there  is 
very  little  about  the  kitchen  that  should  be  left  to  such 
help.  Infirm  people  cannot  work  rapidly  enough  to  ac- 
complish much  in  the  kitchen,  and  frequently  they  are  not 
cleanly  about  their  persons  or  habits,  and  should  not  work 
near  the  food.  Very  few  of  them  do  any  work  about  the 
culinary  department  well,  as  it  is  work  with  which,  as  a 
rule,  they  are  not  familiar. 

The  Feeding  of  Industrial  Workers. 

A  service  that  modern  industrial  corporations  have  set 
for  themselves  in  connection  with  the  general  welfare  of 
their  employees  is  the  midday  meal,  served  sometimes  as 
a  cafeteria  luncheon  and  sometimes  as  a  regularly  served 
meal,  in  which  waitresses,  napery,  and  full  table  service 
are  employed. 

While  it  might  be  conceived  that  the  discussion  of  such 
a  topic  in  a  volume  on  diets  for  the  sick  is  not  appropri- 
ate, yet,  when  we  think  seriously  of  the  matter,  it  is  a 
fair  presumption  that  the  same  principles  of  food  and 


Feeding  Variotcs  Institutions.  Ill 

feeding  are  equally  important  for  the  well  and  sick, 
and  that  they  apply  equally  for  both  classes.  If  foods 
and  feeding  are  among  the  most  important  factors  in 
restoring  to  health  those  who  are  ill,  they  are  equally  im- 
portant in  the  maintenance  of  the  health  of  those  who  are 
well  and  at  work. 

Workers  in  the  industries  are  not  always  the  best 
judges  of  appropriate  foods,  taking  their  employment  and 
their  environment  into  account,  and  hence  those  who  are 
concerned  for  the  health  of  their  employees  are  greatly 
interested  in  the  materials  that  go  into  the  feeding  prob- 
lem and  the  manner  of  their  preparation  and  service. 

The  midday  luncheon  in  the  factory  is  something  more 
than  the  mere  satisfaction  of  the  appetites  of  those  who 
partake ;  it  is  the  sustaining  and  building-up  process  by 
which  workers  are  kept  up  to  the  best  that  is  in  them — 
not  only  for  their  working  hours,  but  in  order  that  their 
lives  may  be  happier  and  healthier,  and  that  they  be  bet- 
ter and  more  useful  citizens,  and  that  their  children 
shall  inherit  stronger  vitality  and  better  constitutions. 

Some  corporations  have  gone  into  these  matters  more 
deeply  than  others.  One  of  the  foremost  in  this  work — 
a  work  that  has  received  national  recognition — is  the 
National  Lamp  Works,  of  Cleveland,  Ohio,  one  of  the  aux- 
iliaries of  the  General  Electric  Company.  This  corpora- 
tion has  worked  for  several  years  in  many  directions  look- 
ing to  the  health  of  industrial  workers,  not  the  least  pro- 
ductive of  which  has  been  in  food  studies  and  feeding 
service.  The  company  has  evolved  into  actual  practice 
some  theories  that  deserve  universal  study  and  more 
general  emulation. 

Below  are  some  of  the  food  types  it  serves  its 
employees,  with  methods  of  preparation,  and  at  the  end 
the  reasons  for  what  it  does  in  terms  of  nutrition. 


112  Modern  Dietetics. 


Split  Pea  Soup. 

Calories 
Quantity  Ingredients  derived  from       Total 

protein  calories 

4      quarts.,  .split  peas  (8  pounds) 3,571.2        12,896 

^Vz  gallons,  .water 

1      quart.. .  .onions  (1  pound  2  ounces) 28.57  224 

1  tablesp . .  baking  soda 

2  gallons,  .milk   (16  pounds) 957.44       5,024 

21/^  cups flour   (10  ounces) 127.2  1,002 

2     pounds,  .fat  (1  pound  butter  and  1  pound 

oleomargarine)    36.32        6,976 

2     teasp.. .  .pepper    

Vz  cup salt   


128  portions 4,720.73      26,122 

1  portion 36.88  204 

Pick  over  and  wash  the  peas,  add  the  water,  and  soak 
overnight;  add  the  onions  and  baking  soda;  cook  gently 
(or  in  a  double  boiler)  in  the  water  in  which  the  peas  were 
soaked;  when  the  peas  are  soft,  press  them  through  a 
strainer,  using  a  potato  masher ;  heat  the  milk  in  a  double 
boiler;  heat  the  butter  and  oleomargarine  in  a  large 
saucepan  or  kettle;  stir  with  a  wooden  spoon;  do  not 
brown  the  fat.  When  the  fat  bubbles,  add  the  flour 
and  seasoning  (which  have  been  mixed  together) ;  stir 
until  perfectly  smooth ;  add  a  portion  of  the  hot  milk,  stir 
constantly,  and  cook  until  the  mixture  thickens ;  then  add 
another  portion  of  the  hot  milk  and  proceed  as  before; 
add  this  to  the  strained  peas  and  heat  until  boiling;  add 
more  seasoning  if  necessary.  Serve  hot.  A  ham  bone 
may  be  cooked  with  the  peas. 


Feeding  Various  Institutions.  113 


Vegetable  Soup. 

Calories 
Quantity  Ingredients  derived  from       Total 

protein  calories 

10     pounds  . .  soup  bones    "j 

1^"  SaspV.V.peppercorns    \  ^0  lbs.  soup  stock . .     262.16  6,800 

5      gallons . .  water  J 

5      pounds .  .lean   beef  ?  0-1/11  n  naK 

1  gallon. .  .water         } ^,141  7,795 

3      pounds .  .pearled  barley  |  462  6  4  8"0 

3  gallons .  .water  j   '  '  "^ 

2  quarts... carrots  (3  pounds) 48.96  477 

2      quarts.,  .turnips  (3  pounds) 48.96  372 

2  quarts.,  .onions  (2^/4  pounds) 57.15  447.75 

1  head cabbage  (small,  21/2  pounds) 63.5  301.5 

2  quarts.,  .tomatoes   (4  pounds) 87.04  412 

4  quarts .  .  .potatoes  (71/2  pounds) 244.8  2,280 

128  portions 3,416.17      23,715.25 

1  portion 26.6  185.27 

Use  soup  bones,  salt,  peppercorns,  and  water  to  make 
soup  stock;  clean  the  bones,  cover  with  2^/2.  gallons  cold 
water,  add  seasoning,  and  cook  at  simmering  temperature 
for  six  or  eight  hours ;  drain  off  the  stock ;  add  2  V2  gallons 
more  cold  water ;  cook  at  simmering  temperature  for  one- 
half  hour ;  drain  into  the  "first"  stock ;  let  it  stand  in  the 
refrigerator  until  needed;  before  using,  remove  all  fat. 
Chop  the  meat  (before  or  after  cooking) ,  add  one  gallon 
cold  water,  and  cook  at  simmering  temperature  until  ten- 
der. Cook  the  pearled  barley  in  water  until  tender; 
wash,  pare,  and  cut  vegetables  by  passing  through  the 
coarsest  knife  of  a  meat  chopper;  cover  with  boiling 
water  and  cook  until  tender;  add  to  soup  stock  cooked 
meat  and  barley;  add  more  seasoning  if  necessary. 
Serve  hot.  Substitute  rice,  macaroni,  or  spaghetti  for 
the  barley. 


114  Modern  Dietetics. 


Potato  Soup. 

Calories 
Quantity  Ingredients  derived  from       Total 

protein  calories 

V2  bushel . .  .potatoes  ( 30  pounds ) 979.2  9,120 

4^  gallons,  .water  (including  water  in  which 

potatoes  were  cooked) 

4V2  gallons,  .milk  (36  pounds) 2,154.24      11,304 

1      quart.. .  .onions  (1  pound  2  ounces) 28.57  224 

IVz  pounds  .  .fat  (%  pound  butter  and  %  pound 

oleomargarine)  27.24        5,232 

4y2  cups flour  (1  pound  2  ounces) 228.6  1.803.4 

1 V2  cups  ....  salt    

1  Vz  tablesp . .  pepper 

3      tablesp.  .celery  salt 

2  cups  ....  chopped  parsley 


128  portions 3,417.85      27,683.4 

1  portion 26.7  216.2 

Wash  and  pare  the  potatoes ;  cover  with  boiling  water 
and  cook  gently  until  tender;  mash  the  potatoes;  chop 
the  onion;  heat  the  onion  and  milk  in  a  double  boiler; 
make  a  sauce  of  the  fat,  flour,  seasoning,  and  hot  milk 
(see  split  pea  soup) ;  add  the  mashed  potatoes,  stir  until 
perfectly  smooth;  heat  the  mixture  until  it  boils;  add 
the  chopped  parsley  and,  if  necessary,  more  seasoning. 
Serve  hot. 


Feeding  Various  Institutions.  115 


Bean  Soup. 

Calories 
Quantity  Ingredients  derived  from       Total 

protein  calories 

IV2  quarts.  ..dried  beans  (15  pounds) 6,123.6        23,460 

12      gallons . .  water 

2      teasp ....  baking  soda 

1      quart. ...  onions  (1  pound  2  ounces) 28.57  224 

V2  cup dried  celery  leaves  or  celery  salt 

cayenne  

4      teasp . . .  .pepper    

V2  cup salt   

1  tablesp.  .mustard  (dry) 

2  cups flour  (1/^  pound) 101.6  801.5 

2     pounds.. fat  (1  pound  butter  and  1  pound 

oleomargarine)    36.32        6,976 


128  portions 6,290.09      31,461.5 

1  portion 49.14  245.8 

Soak  the  beans  overnight  in  water;  drain  excess  of 
water;  then  add  fresh  water,  baking  soda,  sliced  onions, 
and  celery  leaves;  slowly  cook  the  beans  until  they  are 
very  soft;  press  the  beans  through  a  strainer,  using  a 
potato  masher;  heat  the  butter  and  oleomargarine  in  a 
large  saucepan  or  kettle;  stir  with  a  wooden  spoon;  do 
not  brown  the  fat.  When  the  fat  bubbles,  add  the  flour 
and  seasoning,  which  have  been  mixed  together;  stir 
until  perfectly  smooth,  add  a  portion  of  the  strained  bean 
mixture,  stir  constantly,  cook  until  it  thickens ;  then  add 
another  portion  of  the  strained  beans  and  proceed  as 
before ;  after  the  last  portion  of  strained  beans  is  added, 
allow  the  soup  mixture  to  reach  the  boiling  point,  add 
more  water  and  salt  if  necessary.     Serve  hot. 


116 


Modern  Dietetics. 


% 


6 
2 
2 


Quantity 

gallons . 
ounce. . , 
gallons, 
pounds . 
pounds . 


1      cup  . . . . 
1%  tablesp. 


Cream  of  Tomato  Soup. 


Ingredients 


Calories 

derived  from 

protein 

696.32 


.strained  tomatoes  (32  pounds)., 

.  baking    soda 

.milk   (48  pounds) 2,872.32 

.flour 406.4 

.fat  (1  pound  butter  and  1  pound 

oleomargarine)    36.32 

.  salt   

. pepper    


Total 
calories 

3,296 

15,072 
3,206 

6,976 


128  portions 4,011.36      28,550 

1  portion 31.34  223 

Heat  the  tomatoes  to  boiling  point;  add  the  baking 
soda,  stir;  keep  the  tomatoes  hot;  heat  the  milk  in  a 
double  boiler;  make  a  sauce  of  the  fat,  flour,  seasoning, 
and  hot  milk  (see  split  pea  soup) ;  keep  the  sauce  hot; 
just  before  serving  remove  both  the  tomatoes  and  the 
sauce  from  the  fire ;  blend  the  ingredients.     Serve  at  once. 


Feeding  Varioics  iTistitutions.  117 


Cream  of  Bean  Soup. 

Calories 
Quantity  Ingredients  derived  from       Total 

protein  calories 

10     pounds  , .  soup  bones   'I 

l"^'  SaspV.V.peppercorns  [      «°^P  ^'^'^ 262.16        6,800 

5      gallons,  .water  J 

5      pounds.. meat — lean  beef  )  oi/ti  7  7qc^ 

1      gallon... water  j "^'^^^  '''^^ 

11/2  pounds.. dried  beans 612.36       2,346 

1      teasp ....  baking  soda 

3      gallons . .  water 

1/^  cup salt 

1     teasp pepper 

3      gallons.. milk   (24  pounds) 1,436.16        7,536 

11/^  cups flour  (6  ounces) 76.32  601.2 

IVz  pounds,  .fat  (V2  pound  butter  and  1  pound 

oleomargarine)   27.24        5,232 

3      tablesp . .  Worcestershire   sauce 


128  portions 4,555.24      30,310.2 

1  portion 35.59  236.8 

Prepare  the  soup  stock  and  meat  (see  vegetable  soup) ; 
soak  the  beans  overnight  in  water ;  drain  excess  of  water ; 
then  add  the  fresh  water  and  baking  soda,  and  cook 
slowly  until  the  beans  are  very  soft;  press  the  beans 
through  a  strainer,  using  a  potato  masher ;  heat  the  milk 
in  a  double  boiler ;  make  a  sauce  of  the  fat,  flour,  season- 
ing, and  hot  milk  (see  split  pea  soup) ;  add  the  strained 
beans,  cooked  meat,  and  soup  stock;  heat;  if  necessary, 
add  more  seasoning.     Serve  hot. 


118  Modem  Dietetics. 


Cocoa. 

Calories 
Quantity  Ingredients  derived  from       Total 

protein  calories 

4      cups cocoa   (1  pound) 391.92         2,256 

4      cups sugar  (2  pounds) 3,628 

1      gallon ...  water  (2  quarts  cold  water  and 

2  quarts  boiling  water) 

3  gallons. .  .milk  (24  pounds) 1,436.16         7,536 

4  teasp salt    (level) 


128  portions 1,828.08       13,420 

1  portion 21.5  157.9 

Mix  cocoa  and  cold  water;  boil  gently  for  thirty 
minutes,  stirring  occasionally;  heat  the  milk  in  a  double 
boiler,  then  add  the  sugar  and  the  cooked  cocoa  mixture 
to  it ;  heat  for  thirty  minutes ;  do  not  remove  the  scum ; 
before  serving,  add  the  salt,  and  beat  surface  with  a 
Dover  egg  beater.     Serve  hot. 


Feeding  Various  Institutions.  119 


Egg  Sandwiches. 

Calories 
Quantity  Ingredients  derived  from       Total 

protein  calories- 

4      loaves..., sandwich  bread   (128  slices).. . .   1,792  12,800 

32      eggs   (4  pounds) 863.68        2,380 

3  tablesp . .  .salt 

%cup butter   6.72        1,307.4 

cayenne    

4  teasp dry  mustard 

1      tablesp . .  .vinegar 


64   sandwiches 2,662.4        16,487.4 

1  sandwich 41.6  257.6 

Place  eggs  in  hot  water ;  let  simmer,  not  boil,  for  forty 
minutes ;  drain  hot  water  from  them,  add  cold  water,  and 
allow  to  remain  in  water  until  cool;  remove  the  shells, 
chop  the  egg  white,  and  mash  the  egg  yolk ;  add  to  the 
prepared  eggs  the  butter  (which  has  been  melted), 
cayenne,  mustard,  and  vinegar;  mix  thoroughly  and 
spread  on  bread. 


120  Modern  Dietetics. 

Ham  Sandwiches. 

No.  1.  „  .    . 

Calories 
Quantity  Ingredients  derived   from       Total 

protein  calories 

4      loaves.... sandwich  bread  (128  slices) 1,792  12,800 

4      pounds. .  .boiled  ham 1,466.88        5,126.4 

%  pound.... butter   12.52        2,323.2 

Vs  cup salt 

Vz  cup dry  mustard 

cayenne  (use  sparingly) 

3      tabsp ....  vinegar 


64   sandwiches 3,271.4        20,249.6 

1  sandwich 51.1  316.4 

Pass  the  boiled  ham  through  a  meat  grinder;  cream 
the  butter,  add  the  seasoning  and  vinegar;  blend  thor- 
oughly, then  add  the  minced  ham ;  if  necessary,  add  more 
salt.  For  plain  ham  sandwiches  use  %  ounce  butter  for 
each  sandwich  (two  slices  bread) . 

No.  2.  _  ,  . 

Calories 
Quantity  Ingredients  derived   from       Total 

protein  calories 

3  pounds.,  .boiled  ham,  chopped 1,099.44        3,843 

Sauce 

1      cup f at  ( %  cup  butter  and  Vz  cup 

oleomargarine)    9.08        1,744 

11/2  cups flour    (%    pound) 76.2  601 

11/2  quarts....    milk  (3  pounds) 179.52  942 

cayenne    (sparingly) 

1  %  tablesp . . .    dry  mustard 

4  loaves....     sandwich    bread    (32     i/^-inch 

slices  per  loaf) 1,792  12,800 


64  sandwiches    3,156.24      19,930 

1  sandwich   49.3  311.4 

Make  a  sauce  of  the  ingredients  indicated,  in  the  fol- 
lowing manner:  In  a  saucepan,  melt  the  fat;  add  the 
flour,  cayenne,  and  mustard  and  mix  thoroughly;  add  a 
small  portion  of  the  milk ;  heat  until  it  thickens,  stirring 
constantly ;  add  more  of  the  milk,  heat,  and  stir  as  before ; 
continue  until  all  the  milk  has  been  added.  Chop  the 
ham  in  a  food  chopper;  mix  with  the  sauce;  cool  and 
spread  between  slices  of  bread. 


Feeding  Varioits  Institutions.  121 


Cheese  and  Peanut  Sandwiches. 

Calories 
Quantity  InKredients  derived  from       Total 

protein  calories 

4     loaves. . .  .sandwich  bread  (128  slices) 1,792  12,800 

1      pound cheese  522.56        \'^^'^ 

1      pound salted  peanuts   468.12        2,487 

%  cup vinegar 

salt,  if  required 

cayenne  pepper  (use  sparingly)   


64  sandwiches    2,782.68      17,281 

1  sandwich   43.47  270 

Pass  the  cheese  and  peanuts  through  the  meat  grinder ; 
add  the  vinegar  and  seasoning;  mix  thoroughly.  Cut 
the  bread  into  1/2-inch  slices;  spread  generously  with 
the  cheese  mixture ;  if  not  served  at  once,  wrap  the  sand- 
wiches in  dry  towels  and  then  cover  with  towels  wrung 
out  of  hot  water. 


122  Modern  Dietetics. 


Salmon  Sandwiches. 

Calories 
Quantity  Ingredients  derived  from       Total 

protein  calories 

4      cans salmon  (4  pounds) 1,581.92         3,556 

Salad  Dressing 

fat  drained  from  salmon 

1/2  cup flour   ( i/s   pound) 25.4  200 

1      cup milk  (1/2  pound) 29.92  157 

1  cup vinegar 

2  teasp salt 

1  teasp ....      mustard    

pepper    

2      eggs    (4  ounces) 53.92  148.8 

2      lemons,  juice 

cayenne  

salt,  if  needed 

4     loaves ...  .sandwich     bread      (32      ^/^-inch 

slices  per  loaf) 1,792  12,800 


64  sandwiches    3,483.16      16,861.8 

1  sandwich   54.4  263.46 

Remove  the  salmon  from  the  can  and  drain  the  oil  into 
the  top  of  a  double  boiler;  add  the  flour,  salt,  mustard, 
and  pepper  to  the  oil  and  mix  thoroughly;  heat  until  it 
thickens,  stirring  constantly;  add  part  of  the  milk,  stir, 
and  heat  until  it  thickens ;  add  more  milk,  and  repeat  stir- 
ring and  heating  until  all  the  milk  has  been  added ;  then 
add  the  vinegar  and  the  eggs  (which  have  been  beaten) ; 
cook  over  hot  water  and  set  aside  to  cool.  Remove  bits  of 
bone  from  the  salmon;  add  the  salad  dressing,  lemon 
juice,  cayenne,  and  salt  if  needed;  spread  the  mixture 
between  slices  of  bread. 


Feeding  VarioiLS  Institutions.  123 


Cottage  Cheese  Sandwiches. 

Calories 
Quantity  Ingredients  derived  from       Total 

protein  calories 

2  quarts. . .  cottage  cheese  (2  pounds) 755.2  992 

1%  pints olives  (1  pound) 14.52  993 

1      can pimentos    (small) 

Salad  Dressing 

1      cup milk  (1/2  pound) 29.92  157 

4      tablesp...     flour   (1  ounce) 12.72  100.2 

3  tablesp,..     fat    (1  tablesp.  butter  and  2 

tablesp.  oleomargarine)....  1.68  326.8 
1     teasp .....    salt  

V2  teasp .....    mustard    

Vz  cup vinegar 

1      egg  (2  ounces) 26.96  74.4 

4  loaves ...  .sandwich     bread      (32      i/^-inch 

slices  per  loaf) 1,792  12,800 


64  sandwiches    2,633  15,443.4 

1  sandwich   41.1  241.5 

Make  a  salad  dressing  of  the  ingredients  indicated  in 
the  recipe ;  follow  the  method  of  making  the  salad  dress- 
ing given  in  salmon  sandwiches,  substituting  butter  and 
oleomargarine  for  the  oil  drained  from  the  salmon.  Re- 
move the  stones  from  the  olives;  chop  the  olives  and 
pimentos  in  a  food  chopper.  Mix  the  cottage  cheese, 
olives,  pimentos,  and  salad  dressing;  spread  between 
slices  of  bread.    Pickles  may  be  substituted  for  olives. 


124  Modern  Dietetics. 


Sweet  Sandwiches. 

Calories 
Quantity  Ingredients  derived  from       Total 

protein  calories 

3  pounds. .  .raisins  (seeded) 141.48  4,689 

1      pound figs    (dried) 78  1,437 

4  cups sugar  (2  pounds) 3,628 

Vzcup flour   (2  ounces) 25.44  200.4 

4      oranges,  juice  (10%  ounces) 138.6 

8      lemons,  juice  and  rind  (12  ozs.) 133.2 

%  cup water    

4      loaves sandwich     bread      (32      %-inch 

slices  per  loaf) 1,792  12,800 


64  sandwiches    2,036.92      23,026.2 

1  sandwich   31.8  359.8 

Chop  the  raisins  and  figs  in  a  food  chopper;  heat  the 
fruit  juice  and  water;  put  the  flour  and  sugar  in  the  top 
part  of  a  double  boiler  and  mix  thoroughly ;  add  the  hot 
fruit  juice  and  water  to  the  sugar  mixture ;  cook  the  mix- 
ture over  hot  water  for  fifteen  minutes,  stirring  until  it 
thickens;  add  the  chopped  fruits  and  continue  cooking 
until  the  fruit  is  heated  through ;  cool  and  spread  between 
slices  of  bread. 


Feeding  Various  Institutions.  125 


Sardine  Sandwiches. 

Calories 
Quantity  Ingredients  derived  from       Total 

protein  calories 

10     cans sardines  (1  dozen  sardines  in  a 

can,  7  pounds) 2,920.96        8,547 

1%  dozen, . .  .eggs  (2^4  pounds) 485.82        1,338.7 

4      lemons,  juice   (6  ounces) 66.6 

salt 

pepper    

cayenne    

sandwich     bread      (32      ^-inch 
4     loaves ....    slices  per  loaf) 1,792  12,800 


64  sandwiches    5,198.78      22,752.3 

1  sandwich   81.23  355.5 

(For  method  of  cooking  the  eggs,  see  egg  sandwiches.) 
Chop  the  eggs  in  a  food  chopper.  Remove  the  bones 
from  the  sardines  and  break  the  fish  into  pieces ;  add  the 
sardines  and  the  oil  in  which  they  were  canned  to  the 
chopped  eggs ;  add  the  lemon  juice  and  seasonings ;  spread 
between  slices  of  bread. 


126  Modern  Dietetics. 

Energy  Requirement. 

The  energy  requirement,  for  an  average  person,  exer- 
cising moderately,  is  2,500  to  3,000  calories  per  day. 
Estimating  one-third  of  the  day's  rations  as  the  energy 
requirement  of  one  meal,  the  energy  requirement  of  a 
meal  becomes  833  to  1,000  calories. 

It  has  been  estimated  that  from  10  to  15  percent  of  the 
energy  requirements  should  be  furnished  by  protein — 
1.  e.,  nitrogenous  food. 

The  ratio  of  the  fuel  value  of  protein,  or  nitrogenous 
food,  to  the  fuel  value  of  fat  and  carbohydrate,  or  nonni- 
trogenous  food,  is  termed  nutritive  ratio.  In  formulating 
diets,  it  is  helpful  to  have  the  nutritive  ratio  given  with 
the  total  energy  requirement.  Expressing  ratio  in  the 
form  of  a  fraction  and  using  "1"  as  the  numerator,  the 
above  nutritive  ratio  may  be  written  as : 

1/9  to  1/5.7  average  nutritive  ratio — i.  e.,  for  every 
calorie  produced  by  protein,  from  9  to  5.7  calories  should 
be  produced  by  fat  and  carbohydrate. 

The  above  energy  requirement  and  nutritive  ratio  have 
been  taken  as  the  basis  for  "Food  Combinations  for 
Luncheons."  The  calculations  are  based  on  the  following 
factors : 

1  gram  protein  yields  4  calories. 

1  gram  fat  yields  9  calories. 

1  gram  carbohydrate  yields  4  calories. 

Food  Combinations  for  Luncheon. 

Calories 
derived  from       Total 
protein  calories 

1  portion  vegetable  soup 26.6  185.27 

1  cheese  and  peanut  sandwich 43.47  270 

1  large  banana 5.3  100 

1  piece  cake  (2  ounces) 14  200 

1  glass  milk 7.65  150 

97.02  905.27 

Nutritive  ratio,  ^^.3 


Feeding  Various  Institutions.  127 


Calories 
derived  from       Total 
protein  calories 


1  cup  cocoa  21.5  157.9 

1  egg  sandwich 41.6  257.6 

1  portion  ice  cream  ( %  quart) 8.9  244 

1  portion  cake    (2  ounces) 14  200 


86  589.5 
Nutritive  ratio,  %.q 

1  portion  split  pea  soup 36.88  204 

1  ham  sandwich 51.1  ^^^ 

1  portion  ice  cream   ( %  quart) 8.9  244 

1  portion  cake   (2  ounces) 14 


200 


110.88  964.4 
Nutritive  ratio,  y-j.- 

1  portion  vegetable  soup 26.6  185.27 

1  ham  sandwich 51.1  316.4 

1  portion  ice  cream   {Vk  quart) 8.9  244 

1  portion  cake   (2  ounces) 14  200 

100.6  945.67 
Nutritive  ratio,  ^s-4 

1  portion  potato  soup 26.7  ^^^'^ 

1  ham  sandwich 51.1  316.4 

1  large  banana 5.3  100 

1  portion  cake   (2  ounces) 14  200 

1  cup  cocoa 21.5  157.9 

118.6  990.5 
Nutritive  ratio,  ^/7..35 

1  portion  cream  of  tomato  soup 31.34  223 

3  soda  crackers 9-4  100 

1  ham  sandwich 51.1  i  nn 

1  large  banana 5.3  100 

1  portion  cake    (2  ounces) 14  200 

111.14  939.4 
Nutritive  ratio,  ^.4 

1  portion  cream  of  bean  soup 35.59  236.8 

1  egg   sandwich 41.6  257.6 

1  large   orange 6.2  100 

1  large  banana 5.3  100 

1  portion  cake    (2  ounces) 14  200 

102.69  894.4 
Nutritive  ratio,  1^.7 


128 


Modern  Dietetics. 


Calories 

derived  from 

protein 

1  portion  bean  soup 49.14 

2  slices  bread  28 

%  ounce  butter 0.5 

1  portion  ice  cream  ( %  quart) 8.9 

1  large  banana 5.3 


Nutritive  ratio,  %•- 


91.84 


Total 
calories 

245.8 

200 

100 

244 

100 


889.8 


1  portion  potato  soup. 
1  ham  sandwich 

1  portion  cake 

2  apples,  medium  .... 


Nutritive  ratio,  ^.4 


26.7 

216.2 

51.1 

316.4 

14 

200 

7.7 

100 

99.5 


832.6 


1  cup  cocoa  

1  ham  sandwich 

1  portion  ice  cream  (%  quart), 
1  portion  cake   (2  ounces) 


Nutritive  ratio,  %.6 


21.5 

157.9 

51.1 

316.4 

8.9 

244 

14 

200 

95.5 


918.3 


1  portion  bean  soup  (10  ounces) 

1  cottage  cheese  sandwich 

1  portion  ice  cream  ( %  quart) . 
1  portion  cake   (2  ounces) 


Nutritive  ratio,  ^.2 

1  portion  bean  soup  (10  ounces) 

1  ham  sandwich,  No.  2 

1  portion  ice  cream  (%  quart). 
1  portion  cake   (2  ounces) 


49.14 

245.8 

41.1 

241.5 

8.9 

244 

14 

200 

113.14 

931.3 

49.14 

245.8 

49.3 

311.4 

8.9 

244 

14 

200 

Nutritive  ratio,  ^.2 


121.34        1,001.2 


1  portion  split  pea  soup  (10  ounces) 36.88 

1  slice  bread 14 

%  ounce  butter .25 

1  sweet  sandwich 31.8 

1  cup  cocoa 21.5 


Nutritive  ratio,  ^.3 


104.43 


204 

100 

50 

359.8 
157.9 

871.7 


Feeding  Various  Institutions.  129 


Calories 
derived  from       Total 
protein  calories 


1  portion  vegetable  soup  (10  ounces) 26.60  185.27 

1  sardine  sandwich   81.23  355.5 

1  portion  ice  cream   (%  quart) 8.9  244 

1  portion  cake    (2  ounces) 14  200 

Nutritive  ratio,  Ve.s  ^^^'^^  ^^^'^'^ 

1  portion  potato  soup  (10  ounces) 26.7  216.2 

1  salmon  sandwich   54.4  263.46 

1  portion  ice  cream  ( %  quart) 8.9  244 

1  cup  cocoa 21.5  157.9 

1  large  banana 5.3  100 

Nutritive  ratio,  ^.4  ^^^-^  ^^^'^^ 

1  portion  split  pea  soup  (10  ounces) 36.88  204 

3  soda  crackers 9.4  100 

1  salmon  sandwich   54.4  263.46 

1  large   orange 6.2  100 

1  portion  cake 14  200 

Nutritive  ratio,  V,.2  120.88  867.46 

Dietetics  of  the  Future. 

In  the  "sphere  of  woman"  there  is  no  greater  field  for 
work  than  in  the  commissary  departments  of  our  modern 
institutions.  There  is  much  to  be  done,  for  the  ground 
has  not  yet  been  fully  prepared,  and  there  is  great  need 
of  its  being  done.  No  better  laboratory  for  scientific 
work  can  be  found,  and  in  no  place  are  results  more  satis- 
factory; there  is  pleasure  in  seeing  a  patient  not  only 
recover  from  effects  of  a  disease,  but  learn  so  to  control 
his  diet  in  the  future  that  there  will  be  no  recurrence  of 
the  disease.  Of  this  type  of  work  scarcely  enough  is 
being  done  as  yet  to  deserve  mention,  but  it  sets  a  stand- 
ard for  future  work  in  dietetics.  So  many  people  are 
beginning  to  realize  the  value  of  this  knowledge,  and  are 
asking  for  it,  that  many  questions  must  be  answered 
while  waiting  for  the  development  of  this  work,  which  is 


130  Modern  Dietetics. 

coming  "slowly  but  surely."  It  has  been  suggested  that 
cooks  and  dining  room  employees  take  the  same  kind  of 
course  in  dietetics  as  is  given  to  nurses  in  some  train- 
ing schools. 

To  quote  again  from  Dr.  Mendel,  this  statement  may  be 
added:  "In  breaking  away  from  stolid  empiricism  and 
conservative  indifference  in  matters  of  diet,  we  need  not 
be  blind  to  the  valuable  contributions  embodied  in  the 
experience  of  generations  of  mankind.  But  when  the 
physiologist  has  succeeded  in  some  degree  in  interpreting 
or  correcting  this  experience,  it  will  become  the  duty  of 
the  dietitian  and  the  physician  to  act  as  advance  agents 
in  the  promulgation  and  the  application  of  the  newer 
knowledge  in  every-day  life." 


CHAPTER  XVI. 
TRAINING  SCHOOL  WORK  IN  DIETETICS. 

PRELIMINARY  LESSONS— THEORETICAL  AND  PRACTICAL 
METHODS  OF  INSTRUCTION — TEACHING  OF  BASIC  PRIN- 
CIPLES— CLASSIFICATION  OF  SUBJECTS  FOR  CONVENIENT 
TEACHING — COMPARISON  OF  THEORY  AND  PRACTICE. 

In  response  to  numerous  requests  for  suggestions  in 
regard  to  courses  in  dietetics  to  be  given  in  hospitals,  an 
outline  is  submitted  covering  the  points  which  are  essen- 
tial for  an  understanding  of  the  principles  of  dietetics 
and  metabolism,  and  which  can  be  utilized  in  the  larger 
training  schools  having  time  for  a  more  comprehensive 
course  in  dietetics. 

In  training  schools  of  this  type  it  is  almost  universally 
the  custom  to  give  from  three  to  six  preliminary  lessons 
to  the  "probationers"  soon  after  their  entrance  into  the 
school,  and,  as  these  lessons  include  practical  work  in  the 
serving  of  trays,  care  of  food,  care  of  ice  boxes,  keeping 
food  warm,  reheating  gruels,  etc.,  these  matters  are  not 
discussed  in  the  course  planned. 

It  has  been  satisfactory  in  the  majority  of  instances  to 
give  this  classification  of  food  principles  in  outline  form 
and  spend  the  first  two  periods  in  making  it  clear  to  the 
class ;  the  more  common  technical  terms  become  familiar 
enough  to  the  class  to  prevent  confusion,  and  the  entire 
course  is  then  based  on  this  outline. 

As  it  is  almost  invariably  the  custom  to  combine  the 
class  work  in  theory  and  practice,  this  work  is  so  divided 
that,  when  a  subject  is  being  taught  in  which  the  theory' 
is  more  important,  less  time  is  given  to  the  practical ;  and, 
when  less  needs  to  be  said  on  the  subject,  more  time  is 
given  to  the  preparation  of  foods. 

131 


132  Modern  Dietetics. 

For  example,  in  the  lessons  on  vegetables,  fruits,  and 
cereals,  not  so  much  time  need  be  spent  in  discussion,  as 
their  digestion,  metabolism,  etc.,  will  be  given  in  later 
lessons,  but  they  should  have  a  greater  proportion  of  the 
time  given  to  their  preparation,  cooking,  and  serving. 
On  the  other  hand,  as  it  is  not  possible  to  do  any  roasting 
or  boiling  of  meats  in  so  short  a  period  of  time  as  is  given 
for  class  work,  the  practical  work  with  these  foods  need 
consume  less  time.  There  is  much  to  be  said  about 
quality,  storage,  and  selection  of  meat,  and  the  ways  in 
which  its  food  value  is  affected  by  these  things. 

For  the  training  school  giving  a  shorter  course  in  die- 
tetics, twelve  lessons  may  be  given,  covering  the  points 
with  less  detail.  In  any  course  the  basic  principles  should 
be  taught.  The  work  in  theory  should  include  all  that  is 
given  in  the  outline,  except  perhaps  the  subclassification 
of  carbohydrates  and  proteins. 

In  the  practical  work,  one  class  period  should  be  de- 
voted to  food  and  food  principles ;  vegetables,  cereals,  and 
fruits  may  be  combined  in  a  second  lesson ;  the  third  may 
be  lesson  V ;  lessons  VI  and  VII  might  be  condensed  into 
one  lesson,  as  might  also  VIII  and  IX.  The  review  and 
discussion  at  this  point  is  well  worth  the  time  of  one 
class  period.  Fruit  juices  and  frozen  desserts  are  such 
an  important  part  of  the  dietary  of  the  sick  that  the  work 
with  them  and  the  discussion  of  organic  acids  is  most  de- 
sirable, though,  if  necessary,  to  curtail  the  course  further, 
it  would  be  better  to  omit  this  lesson  than  any  of  the  fol- 
lowing ones,  except  lesson  XVI.  The  work  on  leavening 
agents  should  be  omitted  from  the  shorter  course.  By 
giving  the  subject-matter  in  lessons  XVII,  XVIII,  and 
XIX  in  two  lessons,  one  could  cover  the  main  points  of 
the  more  complete  course  fairly  well. 

In  none  of  our  dietetic  courses,  however,  can  we  get  the 
results  we  should  have  unless  the  class  has  had  prelimi- 


Training  School  Work  in  Dietetics.  133 

nary  work  in  physiology,  hygiene,  bacteriology,  and  has 
some  knowledge  of  the  various  diseases  of  the  digestive 
tract.  Under  no  other  conditions  can  they  comprehend 
the  work  in  a  subject  which  is  so  absolutely  new  to  them 
as  dietetics  is  to  most  of  the  classes. 

Theory. 

I.  The  Body. 

A.  Composition. 

B.  Its  needs. 

II.  Food. 

A.  Defined  and  discussed. 

B.  How  food  meets  the  needs  of  the  body. 

III.  The  Five  Food  Principles. 

A.  Defined. 

B.  Source  from  which  obtained. 

C.  Function  in  body. 

D.  Assimilation. 

E.  Elimination. 

IV.  Classification  of  Food  Principles. 

A.  Nonnitrogenous  or  carbonaceous. 
1.  Carbohydrates. 

a.  Polysaccharides. 

1.  Starch — inulin. 

2.  Glycogen. 

3.  Dextrin. 

b.  Disaccharides. 

1.  Sucrose — cane  sugar,  maple  sugar. 

2.  Lactose — milk  sugar. 

3.  Maltose — malt  sugar. 


134  Modern  Dietetics. 

c.  Monosaccharides. 

1.  Glucose — dextrose. 

2.  Fructose — levulose. 

3.  Galactose. 

d.  Gums. 

1.  Pectose. 

2.  Pectin. 

e.  Cellulose. 

2.  Fats. 

a.  Vegetable  fats. 

1.  Olive  oil,  cottonseed  oil,  etc. — 
liquid  at  body  temperature. 

2.  Nuts — high  percent  of  cellulose. 

b.  Animal  fats. 

1.  Butter,  cream,  etc. 

2.  Lard,  suet,  etc. 

3.  Codliver  oil,  bile  salts,  etc. 

3.  Organic  acids. 

B.  Nitrogenous. 
1.  Protein. 

a.  Animal. 

1.  Albumin — lean  meat,  egg  white, 
milk  (lactalbumin). 

2.  Casein,  milk. 

3.  Myosin — muscular  tissue.' 

4.  Fibrinogen — blood. 

5.  Nucleo  protein — celnuclei,  gland- 
ular organs. 

6.  Vitellin — egg  yolk. 

7.  Lecitho  protein — yolk  of  egg,  mu- 
cous membrane,  kidneys ;  contains 
lecithin  (a  phosphorized  fat). 


Training  School  Work  in  Dietetics.  135 

b.  Albuminoids. 

1.  Collagen — connective  tissue,  car- 
tilage. 

2.  Gelatin — artificial    derivative    of 
collagen. 

3.  Keratin — bone,  hoofs,  etc. 

c.  Globulin — in  blood. 

d.  Vegetables. 

1.  Legumin — cereals,  legumes,  pea- 
nuts. 

2.  Glutin — cereals,    grains;    sticky, 
tenacious. 

3.  Gliadin — grains. 

2.  Extractives. 

a.  Amides  in  plants. 

b.  Creatin  in  meats. 

V.  Nutritive  Value  of  Food. 

A.  Caloric  value. 

B.  Nutritive  value. 

VI.  Standard  Dietaries — i.  e.,  things  which  are  gen- 

erally approved  and  things  to  avoid. 

VII.  Diet  in  Disease. 

Practice. 

A  course  of  twenty  lessons  of  two  hours  each,  combin- 
ing theory  and  practice.  When  work  on  any  specific 
subject  is  completed,  a  thorough  review  is  given  and  an 
opportunity  offered  for  the  class  to  correct  any  false 
impressions  or  to  determine  whether  they  have  really 
grasped  the  important  points.  When  necessary,  a  fifteen- 
minute  review  is  given  at  the  beginning  of  the  lesson. 

Lesson  I. 
Theorij. 

Including  divisions  I,  II,  and  III  of  outline. 


136  Modern  Dietetics. 

Lesson  II. 
Theory. 

Carbohydrates — classification. 

Vegetables — composition,  classification. 

Function  in  body — place  in  diet. 

General  rules  for  preparation  and  cooking. 
Practice. 

Cooking  of  type  vegetables. 

Lesson  III. 
Theory. 

Cereals — discussed  in  same  way  as  vegetables. 

Practice. 

Making   gruels — cooking  type   cereals,   combina- 
tions to  make  desserts. 

Lesson  IV. 
Theory. 

Fruits — discussion  same  as  in  vegetables. 
Practice. 

Preparation  of  fruits  served  uncooked. 
Cooking  of  fruits. 

Lesson  V. 
Theory. 

Fats — source,  assimilation,  absorption,  function. 
Practice. 

Experience  with  heating  of  fats — application  to 
cooking  with  frying,  drawn  butter,  sauces,  salad 
dressings. 
Review  of  nonnitrogenous  foods. 

Lesson  VI. 
Theory. 

Protein — classification,  source,  function,  including 
B,  1,  and  2  in  outline. 


Training  School  Wor^k  in  Dietetics.  137 

Lesson  VII. 
Theo7'y. 

Milk — nutritive  value,  care,  preservation,  adulter- 
ants, pasteurization,  sterilization,  peptonizing, 
milk  products. 

Practice. 

Making  junket,  koumiss,  peptonizing  milk,  by 
various  processes. 

Lesson  VIII. 
Theory. 

Eggs,  poultry — nutritive  value,  care,  preservation, 
tests  for  freshness,  rules  for  cooking,  place  in 
diet. 

Practice. 

Cooking  eggs  in  shell  and  out,  omelet,  combina- 
tions of  egg  and  milk  (as  in  egg-nog),  albumin 
drinks,  custards,  goldenrod  eggs,  etc. 

Lesson  IX. 
Theory. 

Fish,  beef,  and  veal ;  mutton  and  lamb ;  pork,  cuts 
of  meat ;  nutritive  value,  affected  by  age  of  ani- 
mal; care;  method  of  killing;  method  of  hand- 
ling after  killing ;  rules  for  cooking. 

P7'actice. 

Broiling  pan  (flame) — fish,  steaks,  bacon;  scalloped 
or  creamed  fish ;  oysters,  stewed  or  fried. 

Lesson  X. 

Review,  theoretical  and  practical. 

Lesson  XI. 

Written  quiz,  and  discussion  of  note  books. 

Lesson  XII. 
Theory. 

Organic  acids — source,  value,  function. 


138  Modern  Dietetics. 

Practice. 

Making  beverages. 

Refreshing — fruit  juices. 
Stimulating — tea,  coffee,  etc. 
Nourishing — cocoa,  milk  drinks. 
Making  sandwiches. 

Lesson  XIII. 
Theory. 

Frozen  mixtures — ices,  creams. 
Combinations — chemistry  of  freezing. 
Value  of  frozen  mixtures  in  dietary  of  sick. 

Practice. 

Frozen  mixtures  of  each  type. 

Lesson  XIV. 
Theory. 

Calorie  defined — value  of  knowing. 
Caloric  value  of  foods. 

Practice. 

Determining  caloric  value  of  some  common  foods. 

Lesson  XV. 
Theory. 

"Balanced"    diet — food    requirement    affected   by 

age,  size,  environment,  etc. 
Dietaries  for  different  people  and  different  condi- 
tions. 

Practice. 

Making  salads. 

Lesson  XVI. 
Theory. 

Leavening  agents — egg,  air,  gas  formed  by  baking 
powder,  soda,  and  acid  medium;  yeast,  applica- 
tion in  cooking. 


Training  School  Work  in  Dietetics.  139 

Practice. 

Making  bread,  muffins,  or  biscuits;  cake.  Class 
divided,  as  it  will  not  be  possible  (as  a  general 
thing)  for  all  to  do  both  types  of  baking  at  one 
lesson. 

Lesson  XVII. 
Theory. 

Diet  in  disease — "indigestion,"  constipation,  skin 
diseases,  "fevers,"  "rheumatism,"  gout,  tuber- 
culosis. 

Practice. 

Same  as  XVI — alternating. 

Lesson  XVIII. 

Diet  in  metabolic  diseases. 

Diabetes,  cardiac  troubles,  nephritis,  gastritis. 

Lesson  XIX. 

Infant  feeding. 

Commercially   prepared   foods,    modified   milk, 
formulas. 

Lesson  XX. 

Examination. 


CHAPTER  XVII. 
SPECIAL  DIETS  AND  PRINCIPAL  FOODS. 

SPECIAL  DIETS  DESIGNED  FOR  USE  IN  THE  HOSPITAL  OR  THE 
HOME — SOME  OF  THE  PRINCIPAL  ARTICLES  OF  FOOD  FOR 
THE  SICK  AND  THEIR  FOOD  VALUES  IN  CALORIES.^ 

LIQUID  DIET. 

Milk  Lemonade   (5  Glasses). 

Protein,  6.4  grams ;  fat,  6.2  grams ;  carbohydrates,  189.5 

grams ;  calories,  909.2. 

Take  6  ounces  (or  3/^  cup)  sugar  and  dissolve  in  1  pint 
boiling  water;  add  14  cup  lemon  juice,  30  c.  c.  (1  sherry- 
glass)  sherry;  then  add  gradually  %  cup  whole  milk; 
stir  well;  strain  through  jelly  bag  until  clear. 

Albuminized  Milk  (2  Glasses). 

Protein,  12.6  grams;  fat,  8.2  grams;  carbohydrates,  18.3 

grams;  calories,  190.2. 

Take  1  egg  white,  1  cup  whole  milk,  1  teaspoon  sugar ; 
put  in  a  glass  jar;  shake  until  thoroughly  mixed.  This 
may  be  flavored  with  1  teaspoon  fruit  juice,  or  a  few 
drops  vanilla  or  a  few  drops  sherry  if  the  patient  may 
have  them. 


lAll  dry  materials  measured  in  spoons  and  cups  are  made  level,  and  all  such 
dry  materials  as  flour,  meal,  powdered  sugar,  etc.,  are  sifted  before  measuring. 
Solid  materials,  such  as  butter,  lard,  etc.,  are  packed  solidly  and  smoothly  into 
spoon  or  cup. 

EQUIVALENTS. 

3  teaspoons =  1  tablespoon....  =        15  c.  c =  ^  ounce 

16  tablespoons =  1  cup =      250  c.  c =  8  ounces 

2  cups ^=  1  pint =      500  c.  c. 

2  pints =:  1  quart =  1,000  c.  c. 

2  tablespoons  butter =:  1  ounce =        30  grams 

4  tablespoons  flour =:  1  ounce 

1  egg =  45-50  grams 

140 


Special  Diets  and  Principal  Foods.  141 

Eiweissmilch. 

Comparison — 8  ounces  whole  milk  will  yield  169  calo- 
ries, and  8  ounces  eiweissmilch  will  yield  95  calories.  To 
increase  eiweissmilch  to  calory  value  of  whole  milk,  add 
%  dram  lactose  to  each  ounce  of  milk. 

Mix  the  curds  of  1  quart  whole  milk  with  1  pint  but- 
termilk made  from  skimmed  milk;  add  water  to  make 
the  whole  quantity  1  quart.  This  gives  protein-high  food, 
which  is  poor  in  salt  and  sugar,  and  the  fat  relatively 

large. 

Difficulties— (a)  Buttermilk  is  not  stable;  (b)  hard  to 
get  curd  fine  enough  to  stay  in  suspension. 

To  make  curd — Boil  milk  5  minutes ;  cool ;  add  chymo- 
gen  in  the  proportion  1  teaspoon  to  1  quart ;  let  stand  one 
hour  at  40°  C;  strain  through  sterile  cheesecloth;  let 
drip  one  to  one  and  one-half  hours ;  press  through  sieve 
twice,  with  buttermilk  and  water  added ;  beat  vigorously. 
Place  in  warm  water  long  enough  to  take  off  chill  from 
milk,  but  use  care  not  to  heat  enough  to  cause  curds  to 
become  lumpy. 

Koumiss. 
Protein,  33   grams;  fat,   40   grams;  carbohydrates,   80 

grams ;  calories,  824. 

Take  4  cups  lukewarm  whole  milk  (1,000  c.  c),  l^ 
yeast  cake  dissolved  in  14  cup  tepid  water,  2  tablespoons 
sugar;  pour  into  bottles  (two-thirds  full)  ;  tightly  cork; 
shake  well;  let  stand  in  warm  place  (100°  F.)  not  less 
than  two  hours  and  not  more  than  six  hours ;  then  place 
on  ice  twenty-four  hours.     Serve  ice  cold. 

Whey  (2  Glasses). 

Take  1  cup  milk,  separated  by  heat  or  acid;  strain 
through  cheesecloth;  to  this  whey  add  30  c.  c.  (1  glass) 
wine,  juice  of  2  lemons,  1  tablespoon  sugar,  1  junket 


142  Modern  Dietetics. 

tablet;  have  the  liquid  lukewarm  when  the  junket  tablet 
is  added ;  when  set,  put  in  a  cool  place.  This  is  a  refresh- 
ing way  of  serving  a  stimulant  or  laxative ;  the  nutritive 
value  is  chiefly  in  the  lactose  and  cane  sugar. 

Beef  Tea  (2  Servings). 

Take  1  pound  meat  (steak) ;  cut  into  1-inch  cubes ; 
cover  with  1  cup  cold  water;  let  stand  one-half  hour  in 
order  to  dissolve  out  the  proteins  soluble  in  cold  water; 
put  in  double  boiler  or  in  Mason  jar  set  in  a  water  bath, 
and  allow  to  simmer  for  one-half  hour  below  boiling 
point;  increase  the  temperature  and  cook  for  one-half 
hour  longer.  Pour  liquid  from  the  meat,  but  do  not 
strain,  as  the  flocculent  particles  contain  the  nourishing 
part  of  the  beef  tea. 

Rice  Gruel  (2  Servings). 

Protein,  10.1  grams ;  fat,  1.3  grams ;  carbohydrates,  28.5 

grams ;  calories,  92. 
Take  1  tablespoon  or  1/2  ounce  rice;  cook  for  one-half 
hour  in  1  cup  skimmed  milk,  using  a  double  boiler  or  an 
asbestos  mat  to  prevent  boiling  of  milk ;  strain  through 
coarse  sieve,  pressing  all  rice  through. 

Rice  Caudle  (4  Servings). 

Protein,  13.8  grams;  fat,  1.9  grams;  carbohydrates,  43.6 

grams ;  calories,  119. 
Cook  rice  and  milk  as  for  gruel,  with  the  addition  of  the 
raisins,  sugar,  and  lemon  rind  or  nutmeg;  strain  all  and 
pour  over  stiffly  beaten  egg  white.  Take  1  tablespoon 
rice,  1  cup  milk,  6  raisins,  grated  rind  of  1/2  lemon  or  very 
little  grated  nutmeg,  1  tablespoon  sugar,  1  egg  white. 

Calf's-Foot  Jelly  (15  to  20  Servings). 

Wash  and  divide  4  feet,  removing  all  fat ;  use  21/2  cups 
water  per  pound ;  cook  slowly  seven  hours ;  strain  and  let 


Special  Diets  and  Principal  Foods.  143 

stand  twelve  hours;  remove  fat;  to  1  quart  of  stock  add 
6  tablespoons  sugar,  rind  and  strained  juice  of  3  lemons, 
2  inches  cinnamon  stick,  3  cloves,  1  bay  leaf,  1  blade  mace, 

2  teaspoons  coriander  seeds,  3  crushed  egg  shells,  beaten 
whites  of  3  eggs ;  let  boil  one  minute  and  stand  ten  min- 
utes to  settle;  strain  through  bag;  add  1  cup  brandy,  V^ 
cup  sherry. 

Van  Noorden's  Gruel  (Amount  Required  for  24  Hours). 

Take  250  grams  oatmeal;  cook  in  two  and  one-quarter 
times  as  much  water  as  oatmeal  for  several  hours  (not 
less  than  eight)  ;  then  add  200  to  300  grams  butter,  5  to 
8  egg  whites  or  100  grams  vegetable  albumin.  Beat  all 
together  until  smooth  and  the  butter  is  well  incorporated. 
On  oatmeal  days  only  coffee  (black)  or  tea,  with  lemon 
juice,  red  wine,  cognac,  or  whisky,  should  be  given.  Ab- 
solutely forbid  all  meat.  Allow  only  vegetable  protein 
and  cooked  egg.  Precede  an  oatmeal  day  usually  by  sev- 
eral strict  diet  days  and  always  one  or  two  green  vege- 
table days.  (Often  longer  time  is  necessary  to  get  sugar 
free.)  After  three  or  four  oatmeal  days,  then  one  or  two 
green  vegetable  days  again. 

DIABETIC  DIET. 

Tomato  Jelly  Salad  (4  Servings). 

Protein,  6.64  grams;  fat,  .9  gram;  carbohydrates,  10.6 

grams ;  calories,  74.1. 
Take  1  cup  tomatoes ;  add  1/2  bay  leaf,  1  sprig  parsley, 

3  whole  cloves,  1  small  slice  onion,  14  teaspoon  salt ;  sim- 
mer about  twenty  to  thirty  minutes;  strain  and  add  1 
teaspoon  gelatin  (that  has  been  soaked  in  3  tablespoons 
cold  water)  to  the  tomato  mixture  while  still  warm ;  pour 
into  small  cups  and  chill.  Serve  on  lettuce  leaves  with 
mayonnaise  dressing. 


144  Modern  Dietetics. 

Wine  Jelly  (5  Servings). 

One    serving,    100    grams — Protein,    2    grams;    fat,    .02 
grams ;  carbohydrates,  127  grams ;  calories,  173. 
Take  II/2  tablespoons  gelatin;  soak  in  1  cup  cold  water; 
dissolve  in  1  cup  boiling  water;  cool;  add  II/2  tablespoons 
sherry,  juice  of  II/2  lemons;  put  into  molds  and  chill. 

Coffee  Charlotte  (3  Servings). 

Protein,   16.2  grams;  fat,   1   gram;  carbohydrates,   2.4 

grams ;  calories,  283.9. 
Soak  1  teaspoon  gelatin  in  3  tablespoons  cold  water; 
add  Vs  cup  boiling  water  to  dissolve  the  gelatin ;  to  this 
add  1  teaspoon  lemon  juice,  2  tablespoons  orange  juice, 
2  tablespoons  coffee ;  chill  the  mixture  to  the  consistency 
of  syrup ;  add  14  cup  whipped  cream,  1/2  ^SS  white  beaten 
stiff ;  fold  all  together ;  put  into  molds  and  chill. 

Coffee  Jelly  (3  Servings). 

Protein,  8.2  grams;  carbohydrates,  .009  grams;  calories, 

33.9. 
Soak  1  tablespoon  gelatin  in  1  cup  cold  water;  add  1 
cup  boiling  coffee,  i/s  grain  saccharin ;  2  or  3  drops  vanilla 
or  sherry  may  be  added  if  desired;  put  into  molds  and 

chill. 

Baked  Cauliflower   (5  Servings). 

Weight  of  mixture,  267  grams— Protein,  21.3  grams;  fat, 
62.1  grams ;  carbohydrates,  8.3  grams ;  calories,  677.8. 
Place  soft  boiled  cauliflower  in  an  open  baking  dish, 

pour  sour  cream,  melted  butter,  and  Parmesan  cheese 

over  it ;  then  bake  in  the  oven. 

Cabbage  SouflBe  (6  Servings). 

Protein,  53.6  grams ;  fat,  72.9  grams ;  carbohydrates,  13.4 

grams ;  calories,  748. 
Boil  1  small  head  of  cabbage  in  salt  water  with  a  small 


Special  Diets  and  Principal  Foods.  145 

onion  and  i/^  pound  minced  ham ;  drain ;  add  1  egg  slightly 
beaten  and  mixed  with  4  tablespoons  sour  cream ;  fold  in 
1  egg  white  beaten  stiff;  put  into  a  baking  dish,  cover 
with  2  ounces  Parmesan  cheese,  and  bake.  May  be  served 
with  tomato  sauce. 

Hollandaise  Sauce  (4  Servings). 

Protein,  8  grams;  fat,  45.6  grams;  carbohydrates,  4.4 

grams;  calories,  461. 
Take  1  egg  yolk  slightly  beaten ;  add  V^  cup  cream,  i^ 
tablespoon  butter;  cook  in  double  boiler,   stirring  con- 
stantly until  a  soft  custard.  To  be  served  with  vegetables. 

Baked  Custard  (3  Servings). 

Protein,  19.3  grams;  fat,  73.1  grams;  carbohydrates,  8.8 

grams;  calories,  717. 
Take  II/2  eggs  slightly  beaten,  1  cup  cream,  %  teaspoon 
either  vanilla  or  sherry;  bake  in  moderate  oven  fifteen 
to  twenty  minutes. 

Bran  Muffins   (12  Muffins). 

One  muffin — Protein,  2.2  grams;  fat,  3.7  grams;  carbo- 
hydrates, 1.8  grams;  calories,  60. 
Take  2  cups  bran  flour,  3  eggs  (beaten  separately),  2 
tablespoons  butter  or  more,  V2  teaspoon  soda,  1  cup  sour 
milk  or  buttermilk,  1  pinch  salt ;  add  egg  yolks  and  milk 
in  which  salt  and  soda  have  been  dissolved;  fold  in 
whites;  if  wished,  add  i/^  cup  nuts;  bake  in  moderate 
oven  twenty  minutes;  if  baked  longer,  they  become  too 
dry. 

Snow  Pudding  (2  Servings). 

One  serving — Protein,  9.12  grams ;  fat,  .42  grams ;  carbo- 
hydrates, 4.9  grams;  calories,  32.7. 
Take  1  teaspoon  gelatin,  1  tablespoon  cold  water,  1  egg 
white,  14  cup  boiling  water,  1  tablespoon  lemon  juice, 


146  Modern  Dietetics. 

saccharin  to  taste ;  soak  the  gelatin  in  cold  water,  dissolve 
in  boiling  water;  strain;  add  the  lemon  juice  and  sac- 
charin ;  set  in  ice  water  to  cool ;  stir  occasionally ;  beat  the 
white  of  the  egg  to  a  stiff  froth,  and,  when  the  gelatin 
begins  to  thicken,  add  the  egg  white  and  beat  all  together 
until  very  light;  chill  in  a  wet  mold.  Serve  with  boiled 
custard. 

Cheese  Souffle  (8  Servings). 

One  serving— Protein,  11.1  grams;  fat,  34.7  grams;  car- 
bohydrates, 1.4  grams ;  calories,  264. 
Grate  2  ounces  Parmesan  cheese  and  2y3  tablespoons 
Swiss  cheese ;  stir  well  with  4%  tablespoons  fresh  melted 
butter,  yolks  of  4  eggs  and  the  whites  beaten  stiff ;  season 
with  ground  white  pepper  and  salt ;  fill  two  small  porce- 
lain molds,  bake  slowly  ten  to  fifteen  minutes,  serve 
quickly. 

Spinach  Pudding  (3  Large  Servings). 

One  serving— Protein,  16.6  grams;  fat,  29.9  grams;  car- 
bohydrates, 5.6  grams ;  calories,  247. 
Mix  1  cup  boiled  spinach,  1  egg  yolk  and  white  whipped 
stiff,  1  slice  onion,  2  tablespoons  cream,  2  tablespoons 
ham  cut  into  cubes ;  place  the  mixture  in  a  well-buttered 
dish  and  steam  in  a  "bain  marie." 

Stuffed  Eggs  (4  Servings).  ..-, 

Protein,  27.6  grams ;  fat,  42.2  grams ;  carbohydrates,  4.9 

grams ;  calories,  526. 
Mash  the  yolks  of  2  hard-boiled  eggs  with  a  lump  of 
butter;  thicken  with  Parmesan  cheese,  1  raw  egg  yolk, 
3  tablespoons  sour  cream ;  fill  the  4  halves  of  the  whites 
of  the  eggs  with  the  mixture,  place  in  a  buttered  dish, 
sprinkle  with  cream  and  cheese,  and  bake  in  the  ovep. 


Special  Diets  and  Principal  Foods. 


147 


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CHAPTER  XVIII. 
COMPOSITION  OF  COMMON  FOODS. 

ATWATER  TABLES  PREPARED  FOR  THE  UNITED  STATES  DE- 
PARTMENT OF  AGRICULTURE — AVERAGE  COMPOSITION  OF 
COMMON  AMERICAN  FOOD  PRODUCTS. 

Careful  selection  of  diets  for  the  sick,  suffering  from 
some  of  the  so-called  diseases  of  metabolism,  must  depend 
on  accurate  knowledge  of  the  chemical  constituents  of 
the  food  articles.  Professor  W.  0.  Atwater,  some  years 
ago,  prepared  a  list  of  the  commoner  foods  used  in  the 
United  States  and  Canada,  with  their  average  chemical 
constituents.  These  tables  have  not  only  withstood  the 
tests  of  time,  but  have  been  confirmed  by  the  principal 
laboratories. 

Not  everyone  has  these  tables  always  at  hand,  and  it 
is  believed  they  may  prove  of  value  in  connection  with 
this  volume. 

The  Atwater  tables  give  the  value  of  food  materials  in 
portions  which  in  the  raw  state  yield  100  calories  of 
energy.  In  special  diet  work,  which  is  being  done  with  as 
much  accuracy  as  possible,  it  is  frequently  desirable  to 
know  the  amount  of  protein,  fat,  and  carbohydrate  in  the 
food  as  it  is  eaten.  For  our  own  convenience  a  table  was 
prepared  in  the  diet  kitchen  of  the  writer  which  includes 
the  foods  we  use  most  commonly  in  such  amounts  as  are 
given  in  an  average  serving.  As  far  as  possible  the  value 
of  the  cooked  food  is  given. 


150 


Composition  of  Common  Foods. 


151 


Food  Materials  (as  purchased). 


Refuse, 
per- 
cent. 


ANIMAL  FOOD. 

Beef,  fresh: 

Chuck  ribs. 

Flank.- 

Loin — - 

Porterhouse  steak 

Sirloin  steak 

Neck 

Ribs - 

Rib  roU 

Round 

Rump 

Shank,  fore 

Shoulder  and  clod 

Fore  quarter.^ 

Hind  quarter - :-,-:-■■; j" 

Beef,  corned,  canned,  pickled,  and 
dried: 

Corned  beef  

Tongue,  pickled..  --•- 

Dried,  salted,  and  smoked.- 

Canned  boiled  beef 

Canned  corned  beef 

Veal: 

Breast 

Leg 

Leg  cutlets 

Fore  quarter 

Hind  quarter 

Mutton: 

Flank 

Leg,  hind.- 

Loin  chops 

Fore  quarter — — 

Hind  quarter,  without  tallow  ... 
Lamb: 

Breast 

Leg,  hind- 

Pork,  fresh: 

Ham._ 

Loin  chops 

Shoulder 

Tenderloin.-- v— ••  "VVj"" 

Pork,  salted,  cured,  and  pickied: 

Ham,  smoked 

Shoulder,  smoked 

Salt  pork - 

Bacon,  smoked — 

Sausage: 

Bologna 

Pork 

Frankfort ._ 

Soups: 

Celery,  cream  of 

Beef 

Meat  Stew - 

Tomato - — 

Poultry: 

Chicken,  broilers 

Fowls - 

Goose - 

Turkey 


16.3 
10.2 
13.3 
12.7 
12.8 
27.6 
20.8 


Water, 
per- 
cent. 


Pro- 
tein, 
per- 
cent. 


7.2 
20.7 
36.9 
16.4 
18.7 
15.7 


8.4 
6.0 
4.7 


21.3 
14.2 
3.4 
24.5 
20.7 

9.9 
18.4 
16.0 
21.2 
17.2 

19.1 
17.4 

10.7 
19.7 
12.4 


13.6 
18.2 


52.6 
54.0 
52.5 
52.4 
54.0 
45.9 
43.8 
63.9 
60.7 
45.0 
42.9 
56.8 
49.1 
50.4 


49.2 
58.9 
53.7 
51.8 
51.8 

52.0 


60. 
68. 
54, 
56 


7.7 
3.3 


Fat, 
per- 
cent. 


41.6 
25.9 
17.6 
22.7 


39.0 
51.2 
42.0 
41.6 
45.4 

45.  5 
52.9 

48.0 
41.8 
44.9 
66.5 

34.8 

36.8 

7.9 

17.4 

55.2 
39.8 
57.2 

88.6 
92.9 
84.5 
90.0 

43.7 
47.1 
38.5 
42.4 


Carbo- 
hy- 
drates, 
per- 
cent. 


15.5 

17.0 

16.1 

19.1 

16.5 

14.5 

13.9 

19.3 

19.0 

13.8 

12.8 

16.4 

14.5 

15.4 


14.3 
11.9 
26.4 
25.5 
26.3 

15.4 
15.5 
20.1 
15.1 
16.2 

13.8 
15.1 
13.5 
12.3 
13. S 

15.4 
15.9 

13.5 
13.4 
12.0 
18.9 

14.2 

13.0 

1.9 

9.1 


15.0 
19.0 
17.5 
17.9 
16.1 
11.9 
21.2 
16.7 
12.8 
20.2 
7.3 
9.8 
17.5 
18.3 


18.2 
13.0 
19.6 

2.1 
4.4 
4.6 
1.8 

12.8 
13.7 
13.4 
16.1 


23.8 
19.2 
6.9 
22.5 
18.7 

11.0 
7.9 
7.5 
6.0 
6.6 

36.9 
14.7 
28.3 
24.5 
23.2 

19.1 
13.6 

25.9 

24.2 
29.8 
13.0 

33.4 
26.6 
86.2 
62.2 

19.7 
44.2 
18.6 

2.8 

.4 

4.3 

1.1 

1.4 
12.3 
29.8 
18.4 


Ash, 
per- 
cent. 


1.1 
1.1 

5.0 
1.1 
5.5 
5.6 


Fuel 

value 
per 

pound, 
calo- 
ries 


.7 
.9 
.8 
.9 
.7 
.7 
.9 
1.0 
.7 
.6 
.9 
.7 
.7 


4.6 
4.3 
8.9 
1.3 
4.0 

.8 
.9 
1.0 
.7 
.8 

.6 

.8 
.7 
.7 
.7 


.8 
.9 

.8 

.8 

.7 

1.0 

4.2 
5.5 
3  9 
4.1 

3.8 
2.2 
3.4 

1.5 
1.2 
1.1 
1.3 

.7 
.7 
.7 
.8 


910 

1,105 

1,025 

1,100 

975 

1,165 

1,135 

1,055 

890 

1,090 

545 

715 

995 

1,045 


1,245 
1,010 
790 
1,410 
1,270 

745 
625 
695 
535 
580 

1,770 
890 
1,415 
1,235 
1,210 

1,075 
860 

1,320 
1,245 
1,450 

895 

1,635 
1,335 
3,555 
2,715 

1,155 
2,075 
1,155 


235 
120 
365 
185 

305 

765 

1.475 

1,060 


152 


Modern  Dietetics. 


Food  Materials  (as  purchased) . 


ANIMAL  FOOD— Cont'd. 

Fish: 

Cod,  dressed 

Halibut,  steaks  or  sections.. 

Mackerel,  whole.- 

Perch,  yellow,  dressed.- 

Shad,  whole 

Shad,  roe.- „ — 

Fish,  preserved: 

Cod,  salt 

Herring,  smoked 

Fish,  canned: 

Salmon — 

Sardines_ 

Shellfish: 

Oysters,  "solids" 

Clams - - 

Crabs 

Lobsters 

Eggs:     Hens'  eggs— 

Dairy  products,  etc.: 

Butter 

Whole  milk 

Skim  milk. 

Buttermilk. _ 

Condensed  milk 

Crean] _ 

Cheese,  cheddar „ 

Cheese,  full  cream 


VEGETABLE  FOOD. 

Flour,  meal,  etc.: 

Entire-wheat  flour 

Graham  flour 

Wheat  flour,  patent  roller  proc- 
ess— 

High-grade  and  medium — 

Low  grade 

Macaroni,  vermicelli,  etc 

Wheat  breakfast  food 

Buckwheat  flour 

Rye  flour 

Corn  meal 

Oat  breakfast  food 

Rice _ 

Tapioca _ 

Starch 

Bread,  pastry,  etc.: 

White  bread 

Brown  bread 

Graham  bread 

Whole-wheat  bread 

Rye  bread _ 

Cake— 

Cream  crackers 

Oyster  crackers 

Soda  crackers 


Refuse, 
per- 
cent. 


29.9 
17.7 
44.7 
35.1 
SO.l 


24.9 

44.4 


*5.0 


52.4 
61.7 

til. 2 


Water, 
per- 
cent. 


58.5 
61.9 
40.4 
50.7 
35.2 
71.2 


40.2 
19.2 

63.5 
53.6 

88.3 
80.8 
36.7 
30.7 
65.5 

11.0 
87.0 
90.5 
91.0 
26.9 
74.0 
27.4 
34.2 


11.4 
11.3 


12.0 
12.0 
10.3 

9.6 
13.6 
12.9 
12.5 

7.7 
12.3 
11.4 


35.3 

43.6 

35.7 

38.4 

35.7 

19.9 

6.8 

4.8 

5.9 


Pro- 
tein, 
per- 
cent. 


11.1 
15.3 
10.2 
12.8 
9.4 
20.9 

16.0 
20.5 

21.8 
23.7 

6.0 

10.6 

7.9 

5.9 

13.1 

1.0 
3.3 
3.4 
3.0 
8.8 
2.5 
27.7 
25.9 


13.8 
13.3 


11.4 

14.0 

13.4 

12.1 

6.4 

6.8 

9.2 

16.7 

8.0 

.4 


9.2 
5.4 
8.9 
9.7 
«.0 
6.3 
9.7 
11.3 
9.8 


Fat, 
per- 
cent. 


.2 

4.4 
4.2 
.7 
4.8 
3.8 

.4 
8.8 

12.1 
12.1 

1.3 

1.1 

.9 

.7 
9.3 

85.0 

4.0 

.3 

.5 

8.3 

18.5 

36.8 

33.7 


1.9 
2.2 


1.0 
1.9 

.9 
1.8 
1.2 

.9 
1.9 
7.3 

.3 

.1 


1.3 

1.8 

1.8 

.9 

.6 

9.0 

12.1 

10.5 

9.1 


Carbo- 

per- 
cent. 


2.6 


3.3 

5.2 

.6 

.2 


5.0 
5.1 
4.8 
54.1 
4.5 
4.1 
2.4 


71.9 
71.4 


75.1 
71.2 
74.1 
75.2 
77.9 
78.7 
75.4 
66.2 
79.0 
88.0 
90.0 

53.1 
47.1 
52.1 
49.7 
53.2 
63.3 
69.7 
70.5 
73.1 


Ash, 
per- 
cent. 


Fuel 
value 
per 
pound, 
calo- 
ries 


.8 
.9 
.7 
.9 
.7 
1.5 

18.5 
7.4 

2.6 
5.3 

1.1 
2.3 
1.5 

.8 
.9 

3.0 
.7 
.7 
.7 

1.9 
.5 

4.0 

3.8 


1.0 
1.8 


.5 

.9 

1.3 

1.3 

.9 

.7 

1.0 

2.1 

.4 

.1 


1.1 
2.1 
1.5 
1.3 
1.5 
1.5 
1.7 
2.9 
2.1 


220 
475 
370 
275 
380 
600 

325 
755 

915 
950 

225 
340 
200 
145 
635 

3,410 
310 
165 
160 

1,430 
865 

2,075 

1,885 


1,650 
1,64c 


1,635 
1,640 
1,645 
1,680 
1.605 
1,620 
1,635 
1,800 
1,620 
1,650 
1,675 

1,200 
1,040 
1,195 
1,130 
1,170 
1,630 
1,925 
1,910 
1.875 


♦Refuse,  oil. 
tRefuse.  shell. 


Composition  of  Common  Foods. 


153 


Food  Materials  (as  purchased) . 


Refuse,  Water, 
per-       per- 
cent,     cent 


VEGETABLE  FOOD— Cont'd. 

Sugars,  etc.: 

Molasses 

Candy  *— 

Honey — 

Sugar,  granulated 

Maple  syrup — 

Vegetables:  t 

Beans,  dried 

Beans,  lima,  shelled— 

Beans,  string — 

Beets 

Cabbage 

Celery -.-■, 

Corn,  green  (sweet),  edible  por- 
tion  

Cucumbers 

Lettuce - 

Mushrooms.- 

Onions 

Parsnips.— j'r-j 

Peas  {Pisum  sativum),  dried.  .... 
Peas  {Pisum.  sativum),  shelled.- 

Cowpeas,  dried. — 

Potatoes 

Rhubarb 

Sweet  potatoes 

Spinach 

Squash 

Tomatoes 

Turnips 

Vegetables,  canned: 

Baked  beans 

Peas  (Pisum  sativum),  green..... 

Corn,  green 

Succotash 

Tomatoes 

Fruits,  dried: 

Apples 

Apricots.- -<- 

Dates 

Figs 

Raisins._ ------ 

Fruits,  berries,  etc.,  fresh:! 

Apples 

Bananas 

Grapes 

Lemons 


7.0 
20.0 
15.0 
20.0 


15.0 
15.0 


10.0 
20.0 


20.0 
40.0 
20.0 


50.0 


Pro- 
tein, 

per- 
cent. 


30.0 


10.0 


10.0 

25.0 
35.0 
25.0 
30.0 


12.6 
68.5 
83.0 
70.0 

77.7 
75.6 

75.4 
81.1 
80.5 
88.1 
78.9 
66.4 
9.5 
74.6 
13.0 
62.6 
56.6 
55.2 
92.3 
44.2 
94.3 
62.7 

68.9 
85.3 
76.1 
75.9 
94.0 

28.1 
29.4 
13.8 
18.8 
13.1 

63.3 
48.9 
58.0 
62.5 


22.5 
7.1 
2.1 
1.3 
1.4 
.9 


Fat, 
per- 
cent. 


Carbo- 
hy- 
drates, 
per- 
cent. 


6.9 
3.6 
2.8 
3.6 
1.2 

1.6 
4.7 
1.9 
4.3 
2.3 


1.8 
.7 
.3 
.1 
.2 
.1 


3.1 

1.1 

.7 

.2 

1.0 

.2 

3.5 

.4 

1.4 

.3 

1.3 

.4 

24.6 

1.0 

7.0 

.5 

21.4 

1.4 

1.8 

.1 

.4 

.4 

1.4 

.6 

2.1 

.3 

.7 

.2 

.9 

.4 

.9 

.1 

2.5 

.2 

1.2 

1.0 

.2 

2.2 
1.0 
2.5 
.3 
3.0 

.3 

.4 

1.2 

.5 


70.0 
96.0 
81.0 
100.0 
71.4 

59.6 

22.0 

6.9 

7.7 

4.8 
2.6 

19.7 

2.6 

2.5 

6.8 

8.9 

10.8 

62.0 

16.9 

60.8 

14.7 

2.2 

21.9 

3.2 

4.5 

3.9 

5.7 

19.6 

9.8 

19.0 

18.6 

4.0 

66.1 
62.5 
70.6 
74.2 
68.5 

10.8 

14.3 

14.4 

5.9 


Ash, 
per- 
cent. 


Fuel 
value 

per 
pound, 
calo- 
ries 


3.5 

1.7 
.7 
.9 
.9 


.7 

.4 

.8 

1.2 

.5 

1.1 

2.9 

1.0 

3.4 

.8 

.4 

.9 

2.1 

.4 

.5 

.6 

2.1 

1.1 

.9 

.9 

.6 

2.0 
2.4 
1.2 
2.4 
3.1 

.3 
.6 

.4 
.4 


1,225 
1,680 
1,420 
1,750 
1,250 

1,520 
540 
170 
160 
115 
65 

440 

65 

65 

185 

190 

230 

1,565 

440 

1,505 

295 

60 

440 

95 

100 

100 

120 

555 
235 
430 
425 
95 

1,185 
1,125 
1,275 
1,280 
1,265 

190 
260 
295 
125 


*Plain  confectionery  not  containing  nuts,  fruit,  or  chocolate. 

tSuch  vegetables  as  potatoes,  squash,  beets,  etc.,  have  a  certain  amount  of  inedible 
material,  skin,  seeds,  etc.  The  amount  varies  with  the  method  of  preparing  the  vege- 
tables, and  cannot  be  accurately  estimated.  The  figures  given  for  refuse  of  vegetables, 
fruits,  etc.,  are  assumed  to  represent  approximately  the  amount  of  refuse  in  these 
foods  as  ordinarily  prepared.  ,.,  ,  ...  ,  .  ,        .  u-  u 

tFruits  contain  a  certain  proportion  of  inedible  materials,  as  skin,  seeds,  etc.,  which 
are  properly  classed  as  refuse.  In  some  fruits,  as  oranges  and  prunes,  the  amount  re- 
jected in  eating  is  practically  the  same  as  refuse.  In  others,  as  apples  and  pears,  more 
or  less  of  the  edible  material  is  ordinarily  rejected  with  the  skin  and  seeds  and  other 
inedible  portions.  The  edible  material  which  is  thus  thrown  away,  and  should  properly 
be  classed  with  the  waste,  is  here  classed  with  the  refuse.  The  figures  for  refuse  here 
given  represent,  as  nearly  as  can  be  ascertained,  the  quantities  ordinarily  rejected. 


154 


Modern  Dietetics. 


Food  Materials  (as  purchased). 

Refuse, 
per- 
cent. 

Water, 
per- 
cent. 

Pro- 
tein, 
per- 
cent. 

Fat, 
per- 
cent. 

Carbo- 

drates, 
per- 
cent. 

Ash, 
per- 
cent. 

Fuel 
value 

per 
pound, 
calo- 
ries 

VEGETABLE  FOOD— Cont'd. 

Fruits,  berries,  etc.,  fresh — Cont'd. 

50.0 
27.0 
10.0 

44.8 
63.4 
76.0 
66.1 
85.8 
85.9 
37.5 

2.7 
2.6 

.6 
37.8 
4.5 
7.2 
3.5 
1.8 
1.4 
1.4 
6.9 
2.0 

.6 
1.0 

5.9 
4.6 

98.2 

.3 
.6 
.5 
.8 
1.0 
.9 
.2 

11.5 
8.6 
3.8 
5.2 
8.1 
2.9 
6.3 
7.5 
5.8 
5.2 

19.5 
8.7 
7.2 
6.9 

12.9 
21.6 

.2 

4.6 

8.5 

12.7 

31.5 

12.6 

7.0 

2.7 

9.5 

3.5 

.6 

35.4 

56.4 

14.3 

31.5 

6.2 

4.3 

6.2 

18.5 

10.2 

3.0 

6.8 

30.3 
37.7 

1.4 

.3 

.4 
.4 
.9 
.6 
.6 
.1 

1.1 

2.0 

.4 

1.1 

1.7 

.9 

1.3 

1.1 

.8 

.7 

1.5 

1.7 

.5 

.6 

2.2 

7.2 

.2 

80 

Oranges  

.1 
.4 
.7 

150 

Pears 

230 

Persimmons,  edible  portion  .  . . 

550 

Raspberries 

220 

Strawberries 

5.0 
59.4 

45.0 
49.6 
86.4 
16.0 
24.0 
*48.8 

.6 
.1 

30.2 

33.7 

8.3 

4.5 

5.3 

25.9 

57.4 

31.3 

25.5 

33.3 

29.1 

36.8 

14.6 

26.6 

48.7 
28.9 

130 

Watermelons 

50 

Nuts: 

Almonds. 

Brazil  nuts 

1,515 
1,485 

Butternuts.  _  _ 

385 

Chestnuts,  fresh. 

915 

Chestnuts,  dried 

1,385 

Cocoanuts 

Cocoanut,  prepared.  

1,295 
2,865 

Filberts 

52.1 
62.2 
53.2 
24.5 
40.6 
,74.1 
58.1 

1,430 

Hickory  nuts.  — 

Pecans,  polished - 

1,145 

1,465 

Peanuts 

1.775 

Pifion  {Pinus  eduKs) 

Walnuts,  black.  

Walnuts,  English. 

Miscellaneous: 

Chocolate 

1,730 

730 

1,250 

2,625 

Cocoa,  powdered. 

2,160 

Cereal   coffee,   infusion    (1   part 
boiled  in  20  parts  water)  t 

30 

♦Milk  and  shell. 

tThe  average  of  five  analyses  of  cereal  coffee  grain  is:  Water  6.2,  protein  13.3,  fat  3.4, 
carbohydrates  72.6  and  ash  4.5  percent.  Only  a  portion  of  the  nutrients,  however, 
enter  into  the  infusion.  The  average  in  the  table  represents  the  available  nutrients  in 
the  beverage.  Infusions  of  genuine  coffee  and  of  tea  like  the  above  contain  practically 
DO  nutrients. 


CHAPTER  XIX. 
SOME  SELECTED  RECIPES  FOR  THE  HOSPITAL. 

SOUPS — FISH  AND  POULTRY — MEATS — VEGETABLES — EGGS — 
SALADS — SALAD  DRESSINGS — SAUCES— DESSERTS — BREADS 
— CAKES — BEVERAGES. 

There  are  cook  books  without  end  and  special  and  gen- 
eral recipes  in  various  forms,  published  to  meet  the  exi- 
gencies of  many  demands,  and  there  are  hospital  diets 
and  recipes  available  to  dietitians  in  modern  institutions. 
No  special  merit,  therefore,  attaches  to  the  recipes  given 
below;  they  are  merely  somewhat  detailed  accounts  of 
the  preparation  and  service  of  some  of  the  dishes  and 
dainties  that  the  author  has  conceived  and  used  with  sat- 
isfaction in  her  own  work.  It  is  hoped  they  may  be  a 
source  of  inspiration  to  other  dietitians,  and  perhaps  an 
occasional  refuge  when  time  urges  and  when  the  exac- 
tions of  disturbing  digestions  and  nervous  doctors  almost 
set  one's  wits  on  end. 

In  the  following  recipes  no  pretense  is  made  of  cover- 
ing a  wide  range  or  of  giving  a  large  number  of  recipes 
in  any  particular  classification  of  foods.  Some  of  these 
were  devised  for  special  diets,  some  for  serving  specific 
groups  of  people,  and  some  just  for  the  purpose  of  lending 
variety.  This  explains  why  some  of  them  are  given  in 
quantities  sufficient  for  large  numbers  of  people  and  some 
for  small  numbers  of  people. 

SOUPS. 
Cream  Soups. 

All  cream  soups  have  a  white  sauce  for  their  founda- 
tion, the  proportion  of  butter  and  flour  varying  according 

155 


156  Modern  Dietetics. 

to  the  consistency  of  the  material  used  and  according  to 
the  thickness  of  soup  desired. 

The  white  sauce  is  made  by  blending  the  flour  and  butter 
until  a  smooth  paste  is  made,  then  pouring  the  hot  milk 
over  the  paste,  stirring  constantly  to  prevent  the  starch 
cooking  too  quickly  and  forming  lumps. 

Cream  of  Almond  Soup  (150  Servings). 

Protein,    951.56   grams;   fat,   2,018.9   grams;   carbohy- 
drates, 1,205.1  grams ;  calories,  26,703.7. 

Take  5  cups  almonds,  3  cups  water,  2  quarts  chicken 
broth,  2  quarts  beef  broth,  2  small  onions  and  2  bunches 
celery  cut  fine ;  white  sauce  made  of  5  cups  flour,  5  cups 
butter,  12  quarts  milk;  blanch  the  almonds;  pound  in  a 
mortar  until  well  broken;  add  water  slowly;  add  stock, 
onion,  celery,  i/2  cup  salt;  simmer  two  hours;  add  white 
sauce. 

Cream  of  Celery  Soup  (100  Servings). 

Protein,  460.6  grams ;  fat,  1,487.4  grams ;  carbohydrates, 
1,021.6  grams;  calories,  19,242. 

Take  3  quarts  strong  celery  broth  made  by  cooking 
yellow  leaves  and  outer  stalks  of  celery ;  add  white  sauce 
made  of  5  cups  flour,  5  cups  butter,  12  quarts  milk,  i/^ 
ounce  celery  salt. 

Cream  of  Corn  Soup  (100  Servings). 

Protein,  632.8  grams;  fat,  1,213.8  grams;  carbohydrates, 
1,898.8  grams ;  calories,  21,002. 

Take  7  No.  IV2  cans  corn,  1  quart  water,  and  cook  until 
soft ;  strain  through  a  sieve ;  add  white  sauce  made  of  3 
cups  flour,  3  cups  butter,  14  quarts  milk,  Va  cup  salt. 


Some  Selected  Recipes  for  the  Hospital.  157 

Duchess  Soup  (125  Servings). 

Protein,  900.6  grams ;  fat,  1,067.8  grams ;  carbohydrates, 
749.3  grams ;  calories,  14,950. 

Take  4  quarts  broth  (beef,  chicken,  or  both) ;  add  white 
sauce  made  of  3  cups  flour,  3  cups  butter,  10  quarts  milk, 
%  cup  salt;  just  before  serving  add  10  eggs  that  are  well 
beaten. 

Cream  of  Pea  Soup  (100  Servings). 

Protein,  695  grams;  fat,  1,165  grams;  carbohydrates, 
1,494  grams;  calories,  19,187. 

Take  7  No.  IV^  cans  common  peas  heated  and  strained ; 
add  white  sauce  made  of  3  cups  flour,  3  cups  butter,  14 
quarts  milk,  %  cup  salt. 

Cream  of  Potato  Soup  (100  Servings). 

Protein,  555  grams;  fat,   1,156  grams;  carbohydrates, 
1,472  grams ;  calories,  18,463. 

Take  3  quarts  mashed  potato ;  add  white  sauce  made  of 
3  cups  flour,  3  cups  butter,  14  quarts  milk,  Vs  cup  salt.  If 
desired,  a  small  amount  of  onion  may  be  sliced  and  put 
into  the  milk,  or  a  few  bay  leaves  may  be  added  to  the 
milk  and  strained  out  before  the  sauce  is  added  to  the 
potato. 

Cream  of  Spinach  Soup  (125  Servings). 

Protein,  749  grams;  fat,   1,660  grams;  carbohydrates, 
1,126  grams ;  calories,  22,350. 

Take  4  quarts  strained  spinach,  thinned  with  2  quarts 
broth ;  add  white  sauce  made  of  5  cups  flour,  5  cups  butter, 
12  quarts  milk,  14,  cup  salt. 


158  Modern  Dietetics. 

Cream  of  Tomato  Soup  (100  Servings). 

Protein,  426  grams;  fat,  1,218  grams;  carbohydrates, 
1,061  grams ;  calories,  16,837. 
Take  2  No.  10  cans  tomato,  cooked  with  1/2  dozen  bay- 
leaves,  1  dozen  cloves,  2  medium-sized  onions  chopped  fine ; 
cook  until  the  onions  are  soft;  strain,  and,  before  adding 
to  the  cream  sauce,  stir  into  the  tomato  1  teaspoon  soda ; 
add  white  sauce  made  of  31/2  cups  flour,  31/2  cups  butter, 
8  quarts  milk,  l^  cup  salt. 

Clam  Chowder  (100  Servings). 

Protein,  268  grams;  fat,  247  grams;  carbohydrates,  785 

grams;  calories,  6,344. 
Take  7  No.  21/2  cans  clam  chowder,  4  quarts  tomato  in 
which  are  cooked  4  medium-sized  onions  (cut  small)  until 
onions  are  soft;  mix  chowder  and  tomato  and  add  3 
quarts  milk.  This  may  be  made  from  fresh  clams  and 
any  desired  vegetables  added. 

Mulligatawny  Soup  (125  Servings). 

Protein,  664  grams;  fat,  933  grams;  carbohydrates,  464 
grams;  calories,  11,068. 

Simmer  for  three  hours  7  quarts  soup  stock,  3  quarts 
tomato,  4  cups  onion,  4  cups  carrot,  2  cups  celery  (onions, 
carrots,  and  celery  cut  fine) ,  2  peppers,  1  tablespoon  cloves, 
2  tablespoons  parsley,  %  cup  salt,  3  cups  flour  made  into 
a  smooth  paste  with  cold  water;  add  6  cups  chicken  cut 
into  small  pieces,  2  cups  butter  which  has  been  browned ; 
strain,  rubbing  the  vegetables  through  a  sieve. 

Tomato  Bouillon  (120  Servings). 

Protein,  343  grams;  fat,  304  grams;  carbohydrates,  585 

grams;  calories,  6,445. 
Take  3  No.  10  cans  tomato,  cooked  with  2  medium-sized 
onions  cut  fine,  3  tablespoons  whole  cloves,  3  bay  leaves ; 


Some  Selected  Recipes  for  the  Hospital.  159 

simmer  until  well  flavored  and  onions  are  soft ;  strain  and 
add  4  quarts  broth,  and,  if  too  strong,  1  to  2  quarts  water. 

FISH  AND  POULTRY. 

Boudins  (100  Servings). 

Protein,  1,322  grams;  fat,  1,416  grams;  carbohydrates, 
325  grams;  calories,  19,305, 

Take  6  quarts  chicken  cut  into  small  pieces,  3  table- 
spoons salt,  %  cup  chopped  parsley  or  1  cup  chopped  cel- 
ery, cayenne;  mix  well;  then  mix  and  add  %  cup  butter, 

1  quart  stock,  2  cups  bread  crumbs ;  add  white  sauce  made 
of  1  cup  flour,  1  cup  butter,  5  cups  milk;  12  egg  yolks, 
well  beaten,  added  last;  put  into  molds  and  bake  in  slow 
oven  fifteen  minutes. 

Jambolaya. 

Cover  the  bottom  of  a  pan  with  slices  of  breakfast 
bacon ;  cut  up  a  chicken  as  for  frying ;  salt  and  pepper ;  dip 
in  flour  and  lay  on  top  of  bacon;  over  this  pour  1  pint 
uncooked  rice,  2  large  onions  chopped  fine,  1  quart  tomato, 

2  pods  red  pepper  chopped  very  fine;  fill  the  pan  with 
water  and  cook  slowly  two  or  three  hours;  put  in  more 
water  if  it  begins  to  dry;  when  ready  to  serve,  stir  in  3 
or  4  tablespoons  butter ;  a  can  of  mushrooms  may  be  added 
to  this  for  those  who  so  desire,  and,  if  used,  should  be 
put  in  at  the  first  on  top  of  the  chicken. 

Roasted  Quail. 

Take  6  quail,  fat,  fresh,  and  tender ;  pick,  draw,  singe, 
and  wipe  with  a  damp  cloth  inside  and  out ;  butter  inside, 
and  sprinkle  with  salt  and  pepper  lightly ;  butter  all  over 
the  outside,  truss,  and  bind  around  with  a  thin  slice  of 
bacon ;  put  1  tablespoon  butter  in  the  roasting  pan,  fit  in 
the  quail,  and  roast  in  a  hot  oven  twenty  to  thirty  minutes, 
according  to  size ;  put  6  slices  hot  buttered  toast  in  a  hot 


160  Modern  Dietetics. 

dish  and  lay  a  quail  on  each ;  add  1/2  tablespoon  butter,  a 
little  boiling  water,  and  juice  of  1  lemon  to  the  gravy  in 
the  pan ;  cook  three  to  four  minutes,  stirring  well ;  strain, 
set  back  on  stove  to  cook  two  minutes  longer ;  then  pour 
evenly  upon  the  breasts  of  the  birds,  so  it  will  soak  into 
the  toast;  garnish  with  sliced  lemon  and  watercress;  if 
grape  leaves  are  to  be  had,  wrap  the  birds  in  them  instead 
of  bacon;  after  preparing  as  directed,  roast,  take  up  on 
toast,  garnish  with  fresh  young  grape  leaves,  and  serve 
with  either  spiced  grapes  or  grape  jelly. 

Codfish  Souffle  (25  Servings). 

Protein,  118  grams;  fat,  61  grams;  carbohydrates,  238 

grams ;  calories,  1,959. 

Take  1  cup  rice,  1  quart  milk,  1  cup  codfish  which  has 
been  soaked  and  broken  into  flakes,  4  egg  yolks  well 
beaten,  salt;  mix  carefully,  fold  in  the  whites  of  eggs 
beaten  until  stiff  and  dry ;  put  into  casseroles  and  bake  in 
a  moderate  oven.     Serve  with  tartar  sauce. 

Baked  Macaroni  and  Oysters. 

Boil  macaroni  until  tender ;  butter  the  bottom  of  baking 
dish ;  put  in  layer  of  macaroni,  then  layer  of  oysters,  small 
bits  of  butter,  sprinkle  with  salt ;  then  add  another  layer 
of  macaroni,  then  more  oysters,  and  continue  alternating 
until  dish  is  nearly  full ;  cover  the  top  layer  with  cracker 
crumbs,  dotted  with  bits  of  butter ;  pour  over  enough  milk 
or  thin  cream  to  come  to  top ;  bake  from  one-half  to  three- 
quarters  of  an  hour. 

Mock  Terrapin  (6  Servings). 

Take  i/^  pound  calf's  liver  cut  into  cubes  and  fried  to  a 
light  brown,  1  salt  spoon  dry  mustard,  3  hard-cooked  eggs 
cut  into  small  pieces,  1  tablespoon  butter,  salt;  melt  but- 


Some  Selected  Recipes  for  the  Hospital.  161 

ter ;  add  liver,  dredged  in  flour ;  stir  all  together ;  add  1  cup 
hot  water.     Serve  on  buttered  toast. 

Salmon  Croquettes,  Spiced  Jelly  Cubes  (50  Croquettes). 

Cook  for  five  minutes  2  tablespoons  finely  chopped  onion 
and  %  cup  finely  chopped  green  pepper  with  %  cup  butter 
and  1  cup  flour;  stir  until  well  blended;  then  pour  on 
gradually,  while  stirring  constantly,  4  cups  rich  milk; 
bring  to  the  boiling  point  and  add  3  teaspoons  salt  and 
1  teaspoon  paprika ;  then  add  7  cups  flaked  salmon ;  spread 
on  plates  to  cool ;  shape  in  the  form  of  croquettes,  dip  in 
egg  and  crumbs,  fry  in  deep  fat  and  drain ;  arrange  around 
mounds  of  spiced  jelly  cubes. 

Spiced  Jelly  Cubes. 

Put  3  cups  cold  water,  2  cups  sugar,  8  cloves,  a  1-inch 
piece  stick  cinnamon  into  a  saucepan,  place  on  range,  stir 
until  sugar  has  dissolved  and  bring  to  the  boiling  point; 
add  2  tablespoons  granulated  gelatin  which  has  been 
soaked  in  4  tablespoons  cold  water  five  minutes;  remove 
from  range  and  stir  until  gelatin  has  dissolved ;  then  add 
1/2  cup  lemon  juice  and  few  grains  salt;  strain  into  two 
oblong  shallow  pans  first  dipped  into  cold  water  and  chill 
thoroughly;  cut  into  cubes. 

Salmon  Loaf  (125  Servings). 

Protein,  7,523  grams ;  fat,  1,730  grams ;  carbohydrates, 
1,402  grams;  calories,  31,168. 

Drain  the  liquor  from  20  No.  1  cans  salmon  and  save  it ; 
mince  the  salmon  and  add  2  cups  melted  butter,  4  quarts 
fine  bread  crumbs,  2  dozen  eggs  well  beaten,  1/4,  cup  salt; 
mix,  mold  into  loaf,  and  bake  in  slow  oven  forty-five 
minutes  to  one  hour.  Serve  with  white  sauce  to  which 
the  liquor  from  salmon  has  been  added,  or  serve  with 
lemon. 


\ 


162  Modern  Dietetics. 

Tuna  Fish. 

Tuna  fish,  mixed  with  a  thick  white  sauce  and  well  fla- 
vored with  salt,  celery  salt,  and  chopped  pimento,  makes 
a  very  pleasing  variety  if  one  serves  fish  often. 

Tuna  fish  salad  made  from  2  parts  fish,  1  part  peas,  1 
part  celery  cut  fine,  and  served  with  a  boiled  dressing,  is 
also  very  good. 

Fish  Chowder  (125  Servings). 

Protein,  627  grams;  fat,   1,142  grams;  carbohydrates, 
1,088  grams;  calories,  17,096. 

Take  3  quarts  fish  cut  into  small  pieces  (the  heads  and 
trimmings  of  the  fish  may  be  boiled  also  and  add  much  to 
the  flavor),  3  pounds  salt  pork  cooked  thoroughly  in  4 
quarts  water ;  strain ;  press  through  strainer ;  add  3  quarts 
potato,  1  cup  onion,  2  quarts  carrot  (potatoes,  onions,  and 
carrots  diced),  few  bay  leaves  if  desired,  3  quarts  tomato, 
4  quarts  milk ;  cook  vegetables  and  bay  leaves  in  tomato 
until  vegetables  are  soft,  then  add  fish  broth  and  hot  milk. 

Baked  Shad. 

Remove  intestinal  organs  and  eyes;  wash  thoroughly 
and  wipe  out  with  a  cheese  cloth ;  stuff,  not  to  full,  and 
sew  up  opening;  place  fish  on  rack,  laying  on  2  strips 
cheese  cloth ;  dredge  with  flour,  salt  and  pepper,  and  lay 
strips  of  salt  pork  on  the  top ;  roast,  allowing  fifteen  min- 
utes to  a  pound. 

Stuffing. 

Take  lA  loaf  bread,  1  tablespoon  chopped  parsley,  2 
tablespoons  chopped  onion,  1/2  teaspoon  sage,  2  eg^  yolks, 
salt  and  pepper,  14  cup  melted  butter ;  mix  thoroughly  in 
order  given. 


Some  Selected  Recipes  for  the  Hospital.  163 

MEATS. 

Bacon  and  Chicken  Liver. 

Cut  bacon  into  strips,  having  it  sliced  very  thin;  roll 
chicken  livers  in  flour,  wrap  bacon  around  pieces  of 
chicken  liver,  and  skewer  with  small  toothpicks  or  small 
skewers ;  cook  in  deep  fat  or  in  a  hot  oven  until  the  bacon 
is  well  done ;  remove  the  skewers  and  serve  hot.  Oysters 
may  be  wrapped  in  bacon  and  served  in  the  same  way. 

Liver  and  Bacon. 

Flour  the  liver  and  sear ;  cut  bacon  into  squares ;  alter- 
nate layers  of  liver  and  bacon,  seasoning  each ;  fill  about 
half  full  of  gravy  made  in  pan  in  which  liver  was  cooked, 
or  with  weak  stock;  cover  and  bake  about  one  hour. 
Gouged  potatoes  may  be  added  after  being  parboiled. 

Boiled  Heart,  Raisin  Sauce. 

Clean,  wash,  and  skewer  a  heart ;  put  into  a  stew  pan, 
cover  with  cold  water,  bring  quickly  to  the  boiling  point, 
and  let  simmer  until  tender,  by  which  time  the  liquor 
should  be  reduced  to  2  cups ;  remove  to  a  hot  serving  dish, 
pour  around  raisin  sauce,  and  garnish  with  parsley. 

Raisin  Sauce. 

Protein,  200  grams;  fat,  96  grams;  carbohydrates,  169 

grams;  calories,  1,615. 

Melt  4  tablespoons  butter,  add  5  tablespoons  flour,  and 
stir  until  well  blended ;  then  pour  on  gradually,  while  stir- 
ring constantly,  the  2  cups  liquor  in  which  the  heart  was 
cooked ;  bring  to  the  boiling  point,  season  with  salt  and 
pepper,  and  let  boil  two  minutes ;  add  1  cup  seeded  raisins, 
1/2  cup  English  walnut  meats  broken  into  pieces,  21/2  table- 
spoons lemon  juice;  again  bring  to  the  boiling  point  and 
pour  around  boiled  heart. 


164  Modern  Dietetics. 

Calves'  Tongues,  Sauce  Piquante. 

Wipe  4  calves'  tongues  with  cheese  cloth  wrung  out  of 
cold  water,  and  cook  in  boiling  water  to  which  has  been 
added  6  slices  carrot,  2  stalks  celery  broken  into  pieces,  1 
onion,  8  cloves,  1  teaspoon  peppercorns,  1/2  tablespoon  salt ; 
take  the  tongues  from  the  water,  remove  the  skin  and 
roots,  and  cut  into  halves  lengthwise;  then  reheat  in 
sauce  piquante. 

Sauce  Piquante. 

Cook  14  cup  butter  until  brown,  stirring  constantly; 
add  6  tablespoons  flour  and  stir  until  well  browned ;  then 
pour  on  gradually,  while  stirring  constantly,  2  cups  brown 
stock;  bring  to  the  boiling  point  and  let  boil  three 
minutes;  add  %  teaspoon  salt,  1/2  teaspoon  paprika,  few 
grains  cayenne,  1  tablespoon  vinegar,  i/^  tablespoon 
capers,  and  1  cucumber  pickle  thinly  sliced. 

Stuffed  Steak. 

Protein,  273  grams;  fat,  400  grams;  carbohydrates,  88 

grams ;  calories,  504. 
Take  2  slices  rump  steak,  1  cup  stale  bread  crumbs,  2 
tablespoons  butter,  1  tablespoon  finely  chopped  onion,  1 
teaspoon  chopped  parsley,  Vs  teaspoon  sage,  1  teaspoon 
salt,  1  egg;  the  meat  should  be  about  1  inch  thick; 
moisten  bread  crumbs  with  hot  water;  then  add  beaten 
egg,  salt,  sage,  onion,  parsley,  and  butter,  which  should  be 
melted;  stir  well  together,  spread  between  the  slices  of 
steak,  and  tie  together  with  a  stout  cord;  put  into  the 
baking  pan  and  bake  in  hot  oven  until  tender ;  baste  often 
with  hot  water  to  which  a  little  strained  tomato  has  been 
added. 

Veal  Birds. 

Wipe  slices  of  veal  from  the  leg,  cut  as  thinly  as  possi- 
ble ;  then  remove  bone,  skin,  and  fat ;  pound  until  l^  inch 


Some  Selected  Recipes  for  the  Hospital.  165 

thick  and  cut  into  pieces  about  21/2  inches  long  by  ll^ 
inches  wide,  each  piece  making  a  bird ;  chop  trimmings  of 
meat,  adding  for  every  3  birds  a  piece  of  fat  salt  pork  1 
inch  square  and  14  inch  thick  (also  chopped) ;  add  to  the 
trimmings  and  pork  half  their  measure  of  fine  cracker 
crumbs  and  season  highly  with  salt,  cayenne,  poultry 
dressing,  lemon  juice,  and  onion  juice ;  moisten  with  beaten 
egg  and  hot  water  or  stock ;  spread  each  piece  with  a  thin 
layer  of  mixture  and  avoid  having  mixture  come  close 
to  the  edge ;  roll  and  fasten  with  skewers ;  sprinkle  with 
salt  and  flour,  and  sauter  in  hot  butter  until  a  golden 
brown;  put  in  stew  pan,  add  cream  to  half  cover  meat, 
cook  slowly  twenty  to  thirty-five  minutes  or  until  tender. 
Serve  on  small  pieces  of  toast,  straining  cream  remaining 
in  pan  over  birds  and  toast,  and  garnish  with  parsley.  A 
thin  white  sauce  in  place  of  cream  may  be  served  around 
birds. 

Veal  Chops  en  Casserole. 

Wipe  6  veal  chops  very  carefully,  to  remove  bits  of  bone 
if  present ;  roll  in  flour  and  sauter  in  hot  fat  until  nicely 
browned  on  both  sides ;  remove  to  a  casserole ;  heat  1  cup 
broth  or  water,  1/2  cup  each  tomato  puree  and  strained 
corn  to  the  boiling  point  and  pour  over  the  chops ;  add  also 
1/2  teaspoon  each  salt  and  pepper;  have  ready  1/2  dozen 
onions  cooked  half  an  hour  and  rinsed  in  cold  water ;  dry 
these  on  a  cloth  and  let  brown  in  a  little  butter  melted  in 
the  frying  pan ;  add  these  to  the  casserole,  cover,  and  let 
cook  very  gently  about  one  hour. 

Broiled  Chicken. 

2-lb.  bird — Protein,  123  grams;  fat,  13  grams;  calories, 

612. 

A  chicken  for  broiling  should  be  young  and  tender. 
Remove  the  head  and  feet,  split  the  fowl  down  the  back 


166  Modern  Dietetics. 

and  draw;  cut  through  the  breast,  dividing  the  fowl  into 
halves;  baste  with  melted  butter  and  broil  fifteen  to 
twenty  minutes,  broiling  the  bony  side  first  in  order  to 
have  the  fleshy  side  browned  and  attractive  for  serving. 

Broiled  Squab. 

Prepare  as  broiled  chicken,  except  the  squab  is  not  cut 
into  halves. 

Baked  Squab. 

Clean  and  draw  the  squab;  stuff  with  any  good  dress- 
ing ;  lay  a  few  small  pieces  of  bacon  across  the  breast  and 
bake  forty-five  to  sixty  minutes,  according  to  size,  in  a 
medium  hot  oven. 

VEGETABLES. 

Apples,  Fried. 

Protein,  3  grams;  fat,  71   grams;  carbohydrates,   177 

grams;  calories,  1,359. 

Take  %  cup  butter,  Vs  cup  sugar,  Vs  cup  water,  6  apples 
(medium  size) ;  make  syrup  of  sugar,  water,  and  butter; 
core  apples;  cut  into  slices  i/^  inch  thick;  fry  in  syrup 
until  clear.  It  may  be  necessary  to  add  more  water  while 
cooking. 

Baked  Bananas. 
No.  1. 

Cut  the  ends  from  bananas  and  bake  until  the  skins 

are  black,  which  will  take  fifteen  to  twenty  minutes  in  a 

hot  oven;  split  the  skins  and  serve  with  sugar  sprinkled 

over  them  or  with  the  banana  sauce.     (See  recipes  for 

sauces.) 

No.  2. 

Protein,  2  grams ;  fat,  5  grams ;  carbohydrates,  33  grams ; 

calories,  181. 

Slice  bananas  in  halves;  for  each  banana  mix  1  tea- 
spoon sugar,  1  teaspoon  butter,  few  drops  lemon  juice; 


Some  Selected  Recipes  for  the  Hospital.  167 

spread  on  the  banana  and  bake  in  a  moderate  oven  twenty 
minutes. 

Baked  bananas  are  much  more  easily  digested  than  raw 
ones,  because  of  the  large  amount  of  starch  which  they 
contain,  and  cooked  starch  is  more  readily  digested  than 
raw. 

Cabbage  (8  Servings). 

Take  cabbage  which  has  been  cooked;  mix  with 
medium  white  sauce;  put  in  baking  dish;  add  cheese 
(grated)  and  buttered  bread  crumbs;  bake  until  golden 
brown ;  or  the  cheese  may  be  dissolved  in  the  white  sauce 
before  pouring  on  the  cabbage. 

Eggplant  Straws. 

Cut  an  unpeeled  eggplant  into  14,-inch  slices,  salt  each, 
put  them  together  again  and  press  them  under  a  heavy 
weight  one  hour  or  more;  cut  them  into  equal  lengths 
1/4  inch  wide,  rejecting  the  skin ;  dry  and  roll  them  in  flour 
mixed  with  an  equal  amount  of  fine  commeal  and  sea- 
soned with  salt  and  a  dash  of  nutmeg;  drop  a  few  at  a 
time  into  hot  oil  and  fry  them  until  they  are  a  delicate 
brown ;  dry  on  soft  paper  and  serve  at  once.  They  should 
be  crisp  and  tender. 

Stuffed  Eggplant  (6  Servings). 

Cook  fifteen  to  thirty  minutes,  according  to  size,  in 
boiling  salted  water;  cut  slice  from  top;  remove  pulp, 
being  careful  not  to  scrape  too  close  to  skin ;  chop  pulp, 
and  for  medium  size  add  1  cup  bread  crumbs,  2  table- 
spoons butter,  1/2  cup  finely  chopped  onion,  seasoning,  1 
egg  well  beaten ;  refill  and  cover  with  crumbs ;  bake  thirty 
to  forty-five  minutes. 


168  Modern  Dietetics. 

Peas. 

Lay  outside  leaves  of  lettuce  in  bottom  of  kettle,  put 
peas  on  top,  gradually  bring  to  a  boil ;  water  from  leaves 
is  sufficient  to  cook  peas,  and  gives  a  delicious  flavor; 
cook  slowly,  season,  putting  in  butter  just  before  serving. 

Mashed  Potato,  Marquise  Style. 

Cook  tomato  puree  until  reduced  to  thick  consistency; 
beat  in  well-mashed  potato;  shape  on  buttered  baking 
dish,  brush  with  beaten  egg  diluted  with  milk ;  set  in  oven 
to  brown  slightly. 

Baked  Squash. 

For  each  piece  of  squash  use  V2  tablespoon  molasses, 
1/^  teaspoon  butter,  melted  together  and  poured  upon 
squash ;  bake  in  hot  oven  forty-five  minutes. 

Tomatoes  Stuffed  With  Ripe  Olives. 

Scoup  out  2  tomatoes  from  the  stem  end ;  chop  1  small 
onion,  fry  in  butter ;  add  the  pulp  removed  from  the  toma- 
toes, 1  cup  ripe  pitted  olives,  2  tablespoons  bread  crumbs ; 
salt  and  pepper ;  put  the  mixture  into  tomatoes  and  bake. 

Jellied  Vegetable  (100  Servings). 

Take  6  envelopes  or  12  tablespoons  gelatin  soaked  in 
3  cups  cold  water ;  pour  3  quarts  hot  water  over  gelatin  to 
dissolve  it;  add  to  gelatin  1  cup  vinegar,  1  cup  lemon  juice, 
2  tablespoons  salt,  3  cups  sugar ;  add  vegetables ;  cut  into 
dice. 

Sweet  Potatoes,  Glazed. 

Protein,  18  grams;  fat,   17  grams;  carbohydrates,  373 

grams;  calories,  1,742. 

Wash  and  pare  6  medium-sized  potatoes;  cook  ten 
minutes  in  boiling  salted  water;  drain,  cut  into  halves 
lengthwise,  and  place  in  a  buttered  pan;  make  a  syrup 


Some  Selected  Recipes  for  the  Hospital.  169 

by  boiling  1/2  cup  sugar  and  4  tablespoons  water  three 
minutes ;  add  1  teaspoon  butter ;  brush  potatoes  with  the 
syrup  and  bake  fifteen  minutes  or  until  soft,  brushing 
twice  with  the  remaining  syrup. 

MEATS  AND  VEGETABLES  COMBINED. 
Stuffed  Apples. 

Fill  with  sausage  or  any  chopped  meat,  using  2  parts 
meat  to  1  part  crumbs ;  pour  water  over  to  prevent  burn- 
ing ;  cover ;  bake  until  apples  are  done. 

Asparagus  and  Eggs  (6  Servings). 

Protein,  48  grams;  fat,  240  grams;  carbohydrates,  11 

grams;  calories,  2,396. 

Take  2  dozen  stalks  asparagus;  cut,  boil,  and  drain; 
1  cup  butter,  browned;  pour  over  asparagus;  stir  well; 
drop  6  eggs  on  top ;  season ;  cook  in  oven  until  eggs  are 
firm. 

Baked  Corn  and  Minced  Ham  (8  to  10  Servings). 

Protein,  65  grams;  fat,  99  grams;  carbohydrates,  143 

grams;  calories,  1,720. 

Take  1  No.  II/2  can  com,  juice  drained  oif ;  1  cup  minced 
ham,  1/2  cup  milk,  1  egg  well  beaten;  salt  and  pepper; 
cover  with  layer  of  buttered  crumbs ;  bake  until  custard 
is  firm. 

Stuffed  Peppers  (12  Servings). 

Take  1  small  onion,  2  slices  bacon ;  chop  finely  and  cook 
together;  add  1  cup  tomato,  crumbs  enough  to  thicken, 
1/2  teaspoon  salt ;  fill  peppers ;  cover  with  crumbs ;  brown 
in  hot  oven.  Chopped  ham  or  veal  may  be  used  instead 
of  bread  crumbs. 


170  Modem  Dietetics. 

Macaroni  a  la  Italienne  (100  Servings). 

Protein,   1,422  grams;  fat,  741  grams;  carbohydrates, 
5,561  grams;  calories,  33,402. 

Take  3  packages  macaroni,  1  gallon  tomato,  2  pounds 
bacon,  2  pounds  cheese,  8  to  12  green  peppers  (according 
to  size),  10  to  12  medium-sized  onions;  boil  macaroni  in 
salted  water  until  tender ;  boil  tomato,  onion,  and  pepper 
one-half  hour ;  fry  bacon  (cut  into  1-inch  strips) ;  cut 
cheese  fine ;  mix  all  together  and  bake  one  hour. 

EGGS. 
Eggs  a  la  Buckingham   (2  Servings). 

Protein,  10  grams ;  fat,  9  grams ;  carbohydrates,  2  grams ; 

calories,  124. 

Take  1  egg,  3  tablespoons  milk,  few  grains  salt;  beat 
egg,  add  salt  and  milk,  and  beat  well ;  then  scramble  over 
a  slow  fire ;  when  nearly  cooked,  serve  on  toast ;  sprinkle 
with  11/2  teaspoons  grated  cheese,  and  toast  under  the 
broiler  to  melt  cheese. 

In  some  sections  of  the  country  a  poached  egg  served 
on  toast,  and  having  the  grated  cheese  sprinkled  over  it, 
is  called  egg  a  la  Buckingham. 

To  cook  an  egg  in  water,  whether  poached  or  in  the 
shell,  the  egg  should  be  dropped  into  boiling  water  and 
then  removed  to  a  lower  heat.  The  water  should  not 
boil  while  the  egg  is  in  it. 

Eggs  a  la  Goldenrod  (2  Servings). 

Protein,   10  grams;  fat,  21   grams;  carbohydrates,   10 

grams;  calories,  269. 

Take  1  egg,  hard  cooked ;  white  sauce  made  of  1  table- 
spoon flour,  1  tablespoon  butter,  Vs  cup  milk,  pinch  of  salt 
(see  cream  soups) ;  cut  white  of  egg  into  strips,  stir  them 


Some  Selected  Recipes  for  the  Hospital.  171 

into  the  white  sauce,  and  pour  on  a  slice  of  toast ;  put  yolk 
through  a  puree  strainer  and  sprinkle  over  the  serving. 

Egg  in  Nest  (1  Serving). 

Separate  egg  yolk  and  white ;  beat  white  until  stiff  and 
dry ;  pile  lightly  on  a  piece  of  toast,  leaving  a  nest  in  the 
center  into  which  the  yolk  may  be  dropped ;  put  into  an 
oven  or  under  a  broiler  until  the  white  is  lightly  browned 
and  the  yolk  cooked. 

Omelet  (1  Large  or  2  Small  Servings). 

Protein,  7  grams ;  fat,  9  grams ;  carbohydrates,  6  grams ; 

calories,  111. 

Take  1  egg,  1  teaspoon  butter,  1  tablespoon  boiling  hot 
water,  few  grains  salt  (an  omelet  made  with  hot  water  is 
less  likely  to  be  tough  than  if  made  with  milk) ;  add  salt 
and  water  to  yolk  and  beat  well;  beat  white  until  stiff, 
then  fold  into  yolk;  grease  pan  with  1  teaspoon  butter; 
cook  omelet  over  a  slow  fire,  finishing  the  cooking  in  the 
oven ;  fold  and  turn  on  a  hot  plate. 

Variations  may  be  made  by  adding  one  of  the  following 
to  the  omelet  before  folding:  jelly,  grated  cheese,  oranges 
(cut  very  fine),  chopped  parsley,  minced  ham,  chipped 
beef  (cut  fine),  pimento  (cut  fine). 

Egg  Souffle  (4  Servings). 

Protein,   22  grams;  fat,   58  grams;  carbohydrates,   19 

grams ;  calories,  682. 

Take  2  eggs  (yolks  and  whites  beaten  separately) ;  add 
salt  and  paprika  to  yolks;  white  sauce  made  of  1  table- 
spoon flour,  1  tablespoon  butter,  1/2  cup  milk,  1/2  cup 
cream ;  stir  yolks  into  the  white  sauce ;  remove  from  fire 
and  fold  in  stiffly  beaten  whites;  pour  into  individual 


172  Modern  Dietetics. 

molds  or  a  casserole,  place  in  pan  of  hot  water,  and  bake 
in  moderate  oven  twenty  to  thirty  minutes.  This  may 
be  served  with  highly  seasoned  sauce  if  desired. 

Eggs  in  Tomato. 

Scoup  out  the  center  from  1  small  tomato,  drop  in  1 
egg  and  sprinkle  with  few  grains  salt;  add  tiny  bit  of 
butter  and  few  bread  crumbs;  cook  in  a  moderate  oven 
fifteen  minutes. 

SALADS. 

Salads  are  valuable  in  the  dietary  because  of  their 
attractiveness  and  the  many  ways  in  which  they  can  be 
made  to  lend  variety.  They  are  often  more  appetizing 
than  nourishing.  To  be  appetizing,  they  should  always 
be  crisp  and  cold. 

They  may  be  garnished  with  head  lettuce,  leaf  lettuce 
(plain  or  shredded),  watercress,  endive,  chicory,  nastur- 
tium leaves,  parsley,  or  many  other  green  leaves  which 
are  available  during  the  spring  and  summer.  Any  of 
these,  except  parsley,  may  be  served  as  a  salad  by  itself. 

All  green  salads  should  be  served  with  French  dressing. 

Apple  Salad  with  Cranberries  (50  Servings). 

Take  6  quarts  uncooked  apples  cut  small,  3  quarts 
cooked  cranberries,  1  pound  white  grapes  cut  into  quar- 
ters, 1  pound  nuts,  juice  of  1  orange,  juice  of  1  lemon,  a 
little  grated  rind  of  lemon. 

Brazilian  Salad. 

Cut  white  grapes  into  halves   (remove  seeds),  equal 
quantity  pineapple  (shredded  or  cut  fine),  14  quantity  cel- 
ery, 14  quantity  nuts. 


Some  Selected  Recipes  for  the  Hospital.  173 

Hot  Chicken  Salad  (60  Servings). 

Take  3  quarts  chicken  (cut  fine),  4  cans  cooked  peas, 
1/^  can  pimento,  14  cup  lemon  juice,  1  quart  white  sauce 
made  of  equal  parts  milk  and  chicken  broth,  salt,  %  cup 
flour.     Serve  with  toast  points. 

Cottage  Cheese  Salad  (70  Servings). 

Take  3  "containers"  milk  (15  or  16  quarts) ;  keep  warm 
until  sour ;  heat  until  curd  forms,  drain  from  milk,  squeeze 
through  cheese  cloth ;  add  3  bunches  celery  chopped  very- 
fine,  1  cup  chopped  olives,  enough  mayonnaise  dressing  to 
soften;  1  cup  chopped  nuts  may  also  be  added. 

Cream  Cheese  (60  Servings). 

Mix  cream  cheese  with  chopped  pecans ;  mold  in  2-inch 
brick;  cut  into  1/2-inch  slices.  Serve  a  heart  of  beet  on 
each  slice. 

Date  and  Cheese  Salad  (60  Servings). 

Cream  6  packages  cheese  with  8  tablespoons  boiled  salad 
dressing ;  wash  dates,  remove  stones,  and  fill  centers  with 
cream  cheese  mixture;  chopped  nuts  may  be  added  to 
cheese.  Serve  3  dates  for  a  helping.  Six  packages  will 
fill  170  dates. 

Jardiniere  Salad  (60  Servings). 

Take  8  cans  peas,  1  cup  peppers  chopped  fine,  1  cup 
onions  chopped  fine,  II/2  cups  sweet  pickle  chopped  fine,  2 
cups  grated  cheese;  cheese  to  be  either  mixed  through 
or  sprinkled  on  top. 

Orange  and  Mint  Salad  (50  Servings). 

Take  %  cup  finely  chopped  mint  and  16  large  oranges ; 
mix  thoroughly  and  let  stand  several  hours.  Served  with 
dressing  made  of  8  tablespoons  powdered  sugar,  4  table- 
spoons lemon  juice,  4  tablespoons  sherry. 


174  Modern  Dietetics. 

Vegetable  Salad. 

No.  1. 
Take  2  parts  peas,  1  part  green  peppers  cut  into  strips ; 
grated  cheese  (American  or  Swiss)  to  be  sprinkled  over 
the  top.     Serve  with  French  dressing. 

No.  2. 
Take  tomato  sliced,  green  pepper  (cut  into  strips  and 
put  over  slice).     Serve  with  French  dressing. 

Peach  Salad. 

Halve  and  stone  large  fresh  peaches;  fill  the  cavities 
with  a  mixture  of  broken  walnuts,  pieces  of  pear,  and  a 
little  celery  or  minced  parsley ;  chill.  When  serving,  gar- 
nish with  parsley  and  serve  with  whipped  cream  dressing. 

Pecan  Salad. 

Place  shredded  lettuce  in  bottom  of  dish,  with  long,  nar- 
row strips  of  American  cheese  across  it ;  sprinkle  chopped 
pecans  over  the  whole.     Serve  with  French  dressing. 

Stuffed  Pepper. 

Take  1  firm  green  pepper  of  as  round  a  shape  as  possi- 
ble ;  cut  off  the  stem  end  and  scoop  out  all  the  pulp ;  let  it 
stand  in  salted  water  ten  minutes ;  wipe  dry  and  fill  with 
a  mixture  (tightly  packed)  made  of  1  soft  cream  cheese, 
14  cup  chopped  English  walnuts  mixed  with  French  dress- 
ing; let  stand  two  or  three  hours;  slice  neatly  with 
a  sharp  knife  (crosswise).  The  white  circles  of  cream 
cheese  with  green  pepper  rims  make  a  very  attractive 
appearance  served  on  crisp  lettuce  leaves.  French  dress- 
ing should  be  served  with  the  salad. 

Tomato  Jelly  (100  Servings). 
Take  4  quarts  tomato,  2  quarts  water,  3  bay  leaves,  1 
dozen  cloves,  1  small  onion,  3  sprigs  parsley,  4  teaspoons 
salt,  4  tablespoons  sugar ;  cook  one  hour ;  strain ;  heat  and 


Some  Selected  Recipes  for  the  Hospital.  175 

pour  on  gelatin  made  of  8  tablespoons  or  4  envelopes  gela- 
tin dissolved  in  1  pint  cold  water. 

Avacado  or  Alligator  Pear. 

The  avacado  or  alligator  pear  is  being  used  to  a  much 
greater  extent  each  year,  and  it  should  be.  As  with  the 
artichoke,  many  people  have  to  learn  to  like  them.  They 
have  much  value  as  a  food,  and  may  be  served  in  many 
ways. 

AS  A  SALAD. 
No.  1. 
Cut  into  longitudinal   sections.      Serve   with   French 

dressing. 

No.  2. 

Slice  the  avacado,  add  equal  parts  sliced  cucumber  and 
sliced  tomato  and  few  shreds  pepper.  Serve  with  either 
mayonnaise  or  French  dressing. 

No.  3. 

Aspic — Mash  the  avacado,  stir  in  a  solution  of  gelatin 
which  has  been  soaked  in  hot  water ;  flavor  with  salt,  cay- 
enne, and  lemon  juice;  let  it  become  solid;  cut  into  cubes. 
Serve  with  mayonnaise. 

AS  A  DESSERT. 

Cut  into  cubes.     Serve  with  sugar  and  cream. 

WITH  SOUP. 

Slice  or  mash  them,  and  serve  in  any  stock  soup.  The 
fruit  may  be  cut  in  half  or  in  sections  and  served,  as 
cantaloupe,  with  salt. 

SALAD  DRESSINGS  AND  SAUCES. 

Tartar  Sauce  (50  Servings). 

Take  1  quart  mayonnaise  and  1/2  cup  whipped  cream, 
and  fold  together;  add  6  medium  pickles,  3  tablespoons 
capers,  3  tablespoons  parsley,  1  shallot  onion,  all  chopped 


176  Modern  Dietetics. 

very  fine;  l^  teaspoon  paprika,  i^  teaspoon  celery  salt, 
little  salt  and  pepper. 

Mayonnaise  Dressing  (3'/^  Quarts). 

Mix  well  1  tablespoon  mustard,  1  tablespoon  salt,  1 
tablespoon  powdered  sugar,  1  teaspoon  cayenne;  add  6 
egg  yolks  well  beaten,  alternated  with  1/2  cup  vinegar  and 
1/2  cup  lemon  juice;  4  to  5  cups  olive  oil.  All  ingredients 
must  be  kept  cold,  and  the  mixture  should  be  beaten  con- 
stantly while  adding  the  oil  and  acid. 

Boiled  Salad  Dressing  (3  Quarts). 

Take  8  tablespoons  flour,  4  tablespoons  mustard,  %  cup 
sugar,  2  tablespoons  salt,  pinch  cayenne;  mix  and  add  3 
cups  vinegar;  cook  until  thick;  add  12  eggs  beaten  and 
mixed  with  6  cups  milk ;  beat  vigorously ;  remove  from  fire 
at  once. 

French  dressing  should  be  made  with  the  proportion  of 
3  parts  oil  to  1  part  acid.  The  acid  may  be  lemon  juice 
or  vinegar,  or  a  mixture  of  both.  The  dressing  may  be 
flavored  with  paprika,  tabasco,  ketchup,  Worcestershire 
sauce,  or  any  relish  desired. 

Sauce  Valentine. 

Into  1  cup  mayonnaise  dressing  beat  2  tablespoons 
grated  horseradish  and  1  teaspoon  mustard;  fold  in  14 
cup  whipped  cream ;  add  salt  and  pepper  as  needed.  Serve 
with  tomato  jelly,  mint  jelly,  jellied  vegetables,  or  with 
cold  meat. 

Oyster  CocktaO  Sauce  (40  Servings). 

Take  ll^  cups  ketchup,  1  cup  acid  (lemon  and  vinegar 
mixed),  1  teaspoon  tabasco  sauce,  1  teaspoon  salt;  mix 
thoroughly;  6  to  8  oysters  in  each  serving;  put  1  table- 


Some  Selected  Recipes  for  the  Hospital  177 

spoon  sauce  on  oysters;  small  amount  of  finely  chopped 

celery  on  top. 

Horseradish  Sauce. 

No.  1.      (50  Servings.) 

Take  3  cups  grated  horseradish  root,  1  cup  vinegar,  salt, 
cayenne,  4  tablespoons  whipped  cream  folded  into  the 
mixture. 

No.  2.    (150  Servings.) 

Mix  2  cups  horseradish  root  with  3  quarts  mayonnaise 
dressing.     This  is  especially  good  served  with  ham. 

Hollandaise  Sauce  (45  Servings). 

Take  21/2  cups  butter,  10  egg  yolks,  5  tablespoons  lemon 
juice,  114  teaspoons  salt,  cayenne,  2  cups  boiling  water; 
divide  butter  into  3  parts ;  add  %  to  yolks  in  double  boiler ; 
cook  until  thick,  adding  second  part ;  when  thick,  add  third 
part,  being  careful  to  stir  thoroughly  and  prevent  cur- 
dling; add  water,  lemon  juice,  and  season;  cook  until 
thick.  This  is  to  be  served  with  steaks  and  fish,  or  it  may 
be  served  with  artichokes  or  asparagus. 

Currant  Mint  Sauce. 

Take  1  quart  currant  jelly  (separated,  but  not  beaten), 
1  scant  cup  finely  chopped  mint  leaves,  shavings  from 
rinds  of  2  oranges.     Served  with  lamb. 

Cranberry  Jelly. 

Measure  berries ;  add  1/2  as  much  water  as  fruit ;  cook 
until  berries  are  soft ;  strain ;  add  1/2  as  much  sugar  as 
berries. 

Bernaise  Sauce  for  Meat  (15  to  20  Servings). 

Take  3  tablespoons  finely  chopped  shallot  (small  mild 
onion),  V2  dozen  peppercorns  or  1  green  pepper,  l^  cup 
vinegar;  simmer  until  nearly  evaporated;  add  2  table- 


178  Modern  Dietetics. 

spoons  butter,  3  egg  yolks  well  beaten;  cook  in  double 
boiler,  stirring  briskly ;  meanwhile  add  2  more  tablespoons 
butter;  when  thickened,  add  salt,  paprika;  strain;  add  1 
teaspoon  each  of  tarragon  and  chervil,  or  1  tablespoon  tar- 
ragon vinegar. 

SAUCES  FOR  PUDDINGS. 
Maple  Pudding  Sauce  (60  Servings). 

Take  8  egg  yolks,  I14  cups  maple  syrup;  cook  until 
smooth;  strain;  beat  until  cool;  fold  in  1  quart  whipped 
cream. 

Orange  Sauce  for  Pudding. 

Take  2  cups  butter,  6  cups  powdered  or  brown  sugar; 
cream ;  add  grated  rinds  of  3  oranges,  2  cups  boiling  water, 
3  cups  orange  juice  (last). 

Hot  Chocolate  Sauce  for  Pudding  (6  Servings). 

Take  1  square  unsweetened  chocolate  (melted) ,  1  table- 
spoon butter ;  blend  thoroughly ;  pour  on  gradually,  while 
stirring  constantly,  %  cup  boiling  water,  1  cup  sugar ;  boil 
fifteen  minutes;  flavor  with  vanilla. 

Sauce  for  Bananas  (Baked  or  Banana  Salad). 

Mash  banana;  add  olive  oil;  thin  with  lemon  juice. 
Serve  on  banana. 

DESSERTS. 
Angel  Custard. 

Protein,   48  grams;  fat,   39  grams;  carbohydrates,   78 

grams ;  calories,  856. 

Take  1  quart  milk;  heat  and  pour  over  stiffly  beaten 
whites  of  4  eggs,  folding  whites  into  milk  while  pouring ; 
2  tablespoons  pulverized  sugar;  2  drops  almond  extract 


Some  Selected  Recipes  for  the  Hospital.  179 

or  2  tablespoons  shredded  almonds ;  bake  in  molds ;  cover 
with  macaroon  crumbs. 

Angel  Parfait  (15  Servings). 

Protein,  24  grams;  fat,  89  grams;  carbohydrates,  142 

grams ;  calories,  1,468. 

Take  1/2  cup  sugar,  V2  cup  water,  whites  of  3  eggs,  1 
pint  cream;  place  sugar  and  water  over  fire  in  a  sauce 
pan  and  stir  until  sugar  dissolves;  boil  without  stirring 
until  it  spins  a  thread ;  meanwhile  beat  until  stiff  and  dry 
the  egg  whites  and  add  to  them  slowly  the  hot  syrup  after 
it  has  been  taken  from  fire  about  one-half  minute ;  when 
cold,  stir  in  gently  1  pint  whipped  cream ;  put  into  mold, 
and  pack  in  ice  and  salt  for  four  hours. 

Coddled  Apples. 

Pare  and  core  apples  and  cook  in  a  thick  syrup,  turning 
occasionally  to  insure  even  cooking;  skim  the  apples  out 
of  the  syrup  and  fill  the  centers  with  chopped  nuts,  or 
jelly,  or  whipped  cream,  or  a  combination  of  any  of  these ; 
pour  the  syrup  around  the  apples  and  let  it  stand  until 
jellied. 

California  Cream  (16  Servings). 

Protein,  79  grams;  fat,  62  grams;  carbohydrates,  258 

grams ;  calories,  1,924. 

Take  2  tablespoons  gelatin,  1  cup  cold  milk,  3  cups  hot 
milk,  1/2  cup  sugar,  4  eggs  beaten  separately,  1  teaspoon 
vanilla,  14  teaspoon  salt;  soak  gelatin  in  cold  milk  and 
dissolve  in  hot  milk ;  add  2  tablespoons  water  to  yolks  of 
eggs  and  beat  well ;  to  them  gradually  add  the  sugar  and 
salt  and  beat  until  sugar  is  well  beaten  in ;  stir  into  the 
hot  milk  and  let  it  almost  reach  the  boiling  point ;  remove 
from  fire  at  once,  and,  when  cool,  pour  over  the  stiffly 
beaten  whites  of  eggs,  to  which  have  been  added  6  table- 


180  Modern  Dietetics. 

spoons  powdered  sugar ;  beat  together ;  add  flavoring  and 
mold. 

Cantaloupe  Sundae  (100  Servings). 
No.  1. 
Make  soft  custard  of  V2  cup  sugar,  1  teaspoon  flour,  1 
egg,  1  cup  milk;  add  l^  cup  chopped  meats  or  fruit; 
freeze  and  fill  V2  cantaloupe. 

No.  2. 
Take  3  quarts  cream  whipped  and  stiffened  with  6 
tablespoons  gelatin  which  has  been  soaked  in  1  cup  cold 
water  and  dissolved  in  1  quart  hot  water;  fold  into  this 
finely  chopped  preserved  ginger  and  1  cup  powdered 
sugar. 

Caramel  Custard  (45  to  50  Servings). 

Protein,  285  grams;  fat,  298  grams;  carbohydrates,  912 

grams ;  calories,  7,529. 

Take  4  quarts  milk  heated,  2  dozen  eggs  beaten  slightly, 

1  teaspoon  salt,  3  cups  sugar  caramelized,  1  tablespoon 
vanilla ;  bake  in  pan  surrounded  with  warm  water. 

Caramelized  Apples. 

Protein,  103  grams ;  fat,  451  grams ;  carbohydrates,  3,425 
grams;  calories,  18,180. 

Take  60  apples  pared  and  cored;  cook  and  boil  them 
together  until  soft  in  8  cups  water,  6  cups  sugar,  1/2  cup 
lemon  juice;  fill  centers  with  8  cups  brown  sugar,  2  cups 
thin  cream,  l/^  cup  butter,  3V^  cups  chopped  nuts,  boiled 
together  until  it  forms  a  soft  ball  in  water.  Serve  with 
whipped  cream. 

Charlotte  Russe  (75  Servings). 

Take  4  tablespoons  or  2  packages  gelatin  and  soak  in 

2  cups  cold  water ;  dissolve  gelatin  in  1  quart  hot  water ; 


Some  Selected  Recipes  for  the  Hospital.  181 

2  cups  sugar,  9  teaspoons  vanilla;  when  slightly  hard- 
ened, fold  in  beaten  whites  of  12  eggs ;  2  quarts  whipped 
cream.    Serve  with  ladyfingers. 

Cherry  Sponge  (25  Servings). 

Take  1  cup  sugar,  1  cup  water ;  add  1  quart  pitted  cher- 
ries; simmer  until  soft;  press  through  colander;  1/2  box 
gelatin  dissolved  in  14  pint  water  in  which  pits  have  been 
stewed,  and  add  the  fruit;  when  jellylike,  whip  to  froth; 
add  beaten  whites  of  2  eggs ;  mold ;  decorate  with  cherries 
and  whipped  cream. 

Coflfee  Ice  Cream  (Individual  Freezer). 

Protein,   8   grams;   fat,   31   grams;   carbohydrates,   68 

grams;  calories,  583. 

Take  14  cup  milk,  1  tablespoon  coffee,  4  tablespoons 
sugar,  and  scald  together ;  1  egg  yolk,  dash  of  salt ;  cook 
in  double  boiler  one  minute;  strain;  add  1/2  cup  cream; 
freeze. 

Cranberry  Ice  (100  Servings). 

Take  8  quarts  cranberries,  4  quarts  water,  4  quarts 
sugar,  juice  12  lemons  (li/^  cups)  ;  cook  cranberries  in 
water;  force  them  through  a  sieve;  add  1  to  2  quarts 
water;  add  sugar  and  lemon  juice;  freeze  to  a  mush. 

Cream  Puffs  (95  Servings). 

Protein,  161  grams;  fat,  509  grams;  carbohydrates,  340 

grams;  calories,  6,839. 

Take  4  cups  water,  2  cups  butter,  4  cups  flour,  16  eggs ; 
boil  water;  add  butter;  when  at  boiling  point  again,  stir 
in  flour  all  at  once  and  beat  until  smooth;  cool  shghtly; 
add  unbeaten  eggs  one  at  a  time ;  bake  thirty  minutes. 


182  Modem  Dietetics. 

Filling  for  Cream  Puffs  (95  Servings). 

Protein,  103  grams;  fat,  95  grams;  carbohydrates,  904 

grams ;  calories,  4,917. 

Take  6  cups  milk  heated;  mix  well  114  cups  flour,  3 
cups  sugar,  and  1  teaspoon  salt,  and  add  to  hot  milk; 
when  starch  is  well  cooked,  add  6  eggs  (well  beaten), 
stirring  constantly;  remove  from  fire;  add  3  teaspoons 
vanilla  or  any  desired  flavoring. 

Date  and  Apple  Meringue. 

Bake  apples ;  fill  centers  with  stewed  dates ;  cover  with 
beaten  whites  of  eggs  into  which  powdered  sugar  is 
folded ;  1  tablespoon  sugar  to  2  whites  of  eggs ;  place  in 
oven  to  brown  meringue. 

Steamed  Date  Pudding  (10  to  12  Servings). 

Protein,  23  grams;  fat,  15  grams;  carbohydrates,  450 

grams ;  calories,  2,528. 

Chop  finely  l^  pound  dates ;  add  1  cup  brown  sugar,  2 
cups  bread  crumbs,  14  pound  chopped  suet,  2  eggs,  juice 
and  grated  rind  of  1  lemon,  1  tablespoon  flour,  1  table- 
spoon molasses ;  steam  three  hours. 

Fruit  Cocktail  (75  Servings). 

Take  8  grapefruits,  5  cans  shredded  pineapple,  12 
bananas,  1  bottle  maraschino ;  cut  into  small  pieces,  mix, 
chill.  Serve  with  sauce  made  of  1  cup  sherry,  6  cups 
sugar,  2  teaspoons  salt. 

Grape  Ice  (3  Servings). 

Carbohydrates,  75  grams;  calories,  300. 

Make  syrup  of  1/2  cup  water  and  l^  cup  sugar;  cool; 
add  l^  cup  grape  juice,  V2  teaspoon  lemon;  cool  and 
freeze. 


Some  Selected  Recipes  for  the  Hospital.  183 

Hamburg  Sponge  (60  Servings). 

Protein,  64  grams;  fat,  48  grams;  carbohydrates,  246 

grams ;  calories,  1,692. 
Heat  juice  of  2  lemons  and  1/2  cup  sugar;  beat  together 
yolks  of  8  eggs  and  1/2  cup  sugar  and  add  to  mixture; 
cook  in  double  boiler  until  thick ;  add  1  tablespoon  gelatin 
softened  in  Vs  cup  cold  water ;  pour  into  a  dish,  and,  when 
partly  set,  fold  in  stiffly  beaten  egg  whites. 

Heavenly  Hash  (75  Servings). 

Take  1/2  dozen  oranges,  4  No.  21/^  cans  sliced  pineapple, 
1  dozen  bananas,  2  cups  nuts,  maraschino  cherries. 

Huntington  Cream  (80  Servings). 

Protein,  581  grams;  fat,  1,625  grams;  carbohydrates, 
1,373  grams ;  calories,  22,755. 
Scald  4  quarts  milk  with  6  cups  almonds ;  beat  yolks  of 
24  eggs  and  add  4  cups  sugar  and  1  teaspoon  salt;  com- 
bine mixtures  and  cook  in  double  boiler,  stirring  con- 
stantly; add  12  teaspoons  gelatin  soaked  in  4  cups  cold 
water ;  cool  slightly ;  add  4  teaspoons  vanilla ;  when  partly 
solid,  cut  and  fold  in  1  quart  heavy  cream,  beaten  stiff ; 
mold  and  chill. 

Plain  Ice  Cream  (100  Servings). 

Protein,  290  grams;  fat,  773  grams;  carbohydrates, 
1,834  grams;  calories,  15,55y. 
Take  5  quarts  milk ;  6  cups  sugar  and  1/2  cup  flour  well 
mixed  and  add  to  milk;  when  starch  is  cooked,  add  S 
eggs  or  12  egg  yolks,  3  quarts  cream,  3  tablespoons  va- 
nilla ;  freeze. 

Lemon  Ice  (3  Servings). 

Carbohydrates,  94  grams ;  calories,  378. 
Make  syrup  of  %  cup  water  and  6  tablespoons  sugar: 
cool;  3  tablespoons  lemon  juice,  few  drops  vanilla,  freeze. 


184  Moderm  Dietetics. 

Macaroon  Cream  (75  Servings). 

Take  8  tablespoons  or  2  boxes  gelatin ;  make  custard  of 
2  cups  cold  water,  4  quarts  scalded  milk,  yolks  of  24  eggs, 
2%  cups  sugar,  1  teaspoon  salt ;  5%  cups  powdered  almond 
macaroons ;  8  teaspoons  vanilla,  whites  of  24  eggs ;  strain 
into  pan ;  add  flavoring  and  macaroons ;  when  thick,  fold 
in  beaten  whites  of  eggs ;  mold. 

Maple  Mousse  (100  Servings). 

Protein,  105  grams ;  fat,  1,436  grams ;  carbohydrates,  744 
grams;  calories,  16,830. 
Take  6  tablespoons  or  3  packages  gelatin  soaked  in  1 
cup  cold  water,  3  quarts  hot  water,  1  quart  maple  syrup, 
2  quarts  whipped  cream;  add  hot  water  and  syrup  to 
soaked  gelatin;  fold  in  whipped  cream. 

Marshmallow  Pudding  (85  Servings). 

Protein,  45  grams ;  fat,  761  grams ;  carbohydrates,  3,938 
grams;  calories,  22,994. 
Take  6  pounds  marshmallows  and  7  cans  pineapple  cut 
into  small  pieces ;  put  layers  alternately  in  pan,  with  few 
nuts  sprinkled  over ;  let  stand  several  hours.  Serve  with 
small  amount  of  whipped  cream  on  top ;  1  quart  whipped 
cream  is  enough  for  this  recipe. 

Toasted  Marshmallows. 

Protein,  171  grams;  fat,  1  gram;  carbohydrates,  1,920 

grams ;  calories,  8,392. 
Take  8  tablespoons  granulated  gelatin,  8  cups  boiling 
water,  8  cups  sugar,  whites  of  20  eggs,  II/2  tablespoons 
vanilla,  macaroons ;  dissolve  gelatin  in  boiling  water ;  add 
sugar ;  when  dissolved,  put  bowl  on  ice ;  add  egg  whites 
and  vanilla ;  beat  until  mixture  thickens ;  turn  into  shal- 
low pan;  chill;  cut  into  squares  and  roll  in  macaroon 
crumbs.    Serve  with  cream. 


Some  Selected  Recipes  for  the  Hospital.  185 

Pineapple  Bavarian  (60  Servings). 

Protein,  148  grams ;  fat,  731  grams ;  carbohydrates,  1,171 
grams;  calories,  11,636. 

Take  2  small  cans  or  6  cups  grated  pineapple;  2  cups 
sugar,  2  boxes  gelatin  (8  tablespoons),  1  quart  whipped 
cream,  juice  of  6  lemons,  1  cup  cold  water,  3  cups  boiling 
water,  whites  of  8  eggs ;  soak  gelatin  in  1  cup  cold  water ; 
pour  3  cups  boiling  water  over  gelatin;  put  pineapple 
and  sugar  in  sauce  pan;  let  simmer  until  sugar  is  dis- 
solved ;  add  this  to  gelatin  and  lemon  juice ;  let  cool ;  when 
thickening  add  whipped  cream  and  beaten  whites. 

Pineapple  Pudding. 

Protein,    101    grams;   fat,    122   grams;    carbohydrates, 
4,026  grams;  calories,  17,641. 

Take  10  No.  IV2  cans  shredded  pineapple,  heated;  mix 
well  2 1/2  cups  sugar  and  I14  cups  cornstarch,  and  add  to 
pineapple;  1  quart  water;  cook  until  starch  is  clear  and 
thoroughly  cooked ;  add  10  eggs  well  beaten ;  remove  from 
fire  at  once. 

Prune  Loaf  (75  Servings). 

Protein,  208  grams ;  fat,  177  grams ;  carbohydrates,  1,061 

grams;  calories,  6,669. 

Take  3  boxes  or  12  tablespoons  gelatin  soaked  in  1  cup 
cold  water  and  dissolved  in  2i/^  quarts  hot  water;  chop 
medium  fine  II/2  boxes  raisins,  2  cups  English  walnut 
meats,  2 VI  quarts  prunes,  1  tablespoon  cinnamon;  add  % 
cup  lemon  juice;  mix  all  together;  mold.  Serve  with 
whipped  cream. 

Prune  Whip  (50  Servings). 

Protein,  116  grams;  fat,  718  grams;  carbohydrates,  1,577 
grams ;  calories,  13,486. 

Take  3  pounds  prunes  washed  and  soaked  in  cold 
water  overnight ;  bring  to  boil,  cook  until  soft ;  wash  and 


186  Modern  Dietetics. 

remove  stones ;  add  6  tablespoons  gelatin,  li/^  cups  sugar, 
V2  cup  lemon  juice,  2  cups  cold  prune  juice,  6  cups  boil- 
ing prune  juice;  set  in  a  pan  of  ice,  and,  when  partly  set, 
add  1  quart  whipped  cream. 

Rice  Surprise  (85  Servings). 

Protein,  223  grams;  fat,  2,191  grams;  carbohydrates, 
3,132  grams;  calories,  33,897. 

Take  2  quarts  rice ;  cook  in  6  quarts  water ;  cool ;  add 
5  cans  shredded  pineapple;  sugar;  let  stand  several 
hours ;  add  3  quarts  whipped  cream. 

Spanish  Cream  (75  Servings). 

Protein,  304  grams;  fat,  205  grams;  carbohydrates,  624 

grams;  calories,  5,598. 

Take  1  quart  hot  strong  coffee,  3  cups  cold  milk,  2 
quarts  and  1  cup  hot  milk,  10  tablespoons  or  21/2  boxes 
gelatin,  15  egg  whites,  15  egg  yolks,  2  cups  sugar,  salt; 
soak  gelatin  in  cold  milk  and  add  boiling  coffee;  scald 
milk  and  add  beaten  yolks  and  sugar;  cook  over  hot 
water  until  it  coats  a  spoon;  add  coffee  with  dissolved 
gelatin ;  chill ;  when  set,  fold  in  beaten  egg  whites. 

Strawberry  Bavarian  (50  Servings). 

Protein,  112  grams;  fat,  719  grams;  carbohydrates,  533 

grams ;  calories,  9,312. 

Take  5  cups  crushed  strawberries,  2  cups  sugar,  juice 
of  5  lemons,  6  tablespoons  gelatin,  4  cups  water,  6  egg 
whites,  1  quart  whipped  cream ;  soak  gelatin  in  1  cup  cold 
water;  add  3  cups  boiling  water,  sugar,  lemon  juice,  and 
strawberries;  let  stand  on  ice  until  thickened;  when 
thickening,  fold  in  whipped  cream  and  beaten  egg  whites ; 
crush  strawberries  with  some  of  the  sugar  and  let  stand 
for  a  time  before  using. 


Some  Selected  Recipes  for  the  Hospital.  187 

Washington  Sponge  (50  Servings). 

Protein,  128  grams;  fat,  1  gram;  carbohydrates,  1,103 

grams ;  calories,  4,948. 

Take  6  tablespoons  or  II/2  boxes  gelatin,  1  quart  cold 
water,  2  quarts  boiling  water,  41/2  cups  sugar,  1  cup 
lemon  juice,  15  egg  whites;  soak  gelatin  in  cold  water; 
add  boiling  water,  sugar,  lemon  juice;  when  cool,  put  on 
ice  until  thick ;  fold  in  egg  whites  beaten  stiff.  Serve  with 
custard  sauce  made  of  12  egg  yolks,  1  cup  sugar,  3  pints 
milk,  %  cup  sherry ;  cook  in  double  boiler  until  it  coats  a 
metal  spoon ;  add  sherry  and  serve  cold. 

Whipped  Cream  Dessert  (100  Servings). 

Protein,  63  grams ;  fat,  1,077  grams ;  carbohydrates,  164 

grams ;  calories,  10,980. 

Take  li/^  quarts  whipped  cream,  3  tablespoons  gelatin 
soaked  in  1/2  cup  cold  water ;  1  cup  boiling  water ;  add  to 
soaked  gelatin ;  V2  cup  sugar ;  add  cooled  gelatin  solution 
slowly  to  whipped  cream,  beating  at  the  same  time.  Serve 
with  raspberry  sauce  made  as  follows : 

Raspberry  Sauce  (100  Servings). 

Take  1  tablespoon  cornstarch  moistened  with  water; 
cook  until  smooth;  2  tablespoons  sherry;  add  cornstarch 
with  sherry  to  2  cups  jam. 

Milk  Sherbet  (160  Servings). 

Protein,    634   grams;   fat,    768    grams;    carbohydrates, 
17,550  grams;  calories,  75,666. 

Make  syrup  of  juice  of  40  lemons  and  8  quarts  sugar; 
heat  slightly  20  quarts  milk  and  add  to  the  syrup  while 
it  is  still  slightly  warm,  beating  all  the  time;  freeze  at 
once  to  prevent  curdling. 


188  Modern  Dietetics. 

Fruit  Gelatin  (75  Servings). 

Soak  6  tablespoons  or  3  packages  gelatin  in  1  quart  cold 
water ;  dissolve  gelatin  in  2  quarts  hot  water  and  1  quart 
fruit  juice ;  3i/^  to  4  quarts  fruit ;  sugar  according  to  kind 
of  fruit  used.    Serve  with  1  quart  whipped  cream. 

Neapolitan  Pudding  (150  Servings). 

Take  4  packages  or  8  tablespoons  gelatin  soaked  in  2 
cups  cold  water  and  dissolved  in  1  quart  hot  water ;  divide 
into  3  equal  parts ;  to  2  cups  add  1  quart  coffee,  sugar,  and 
vanilla;  to  2  cups  add  1  pint  maraschino,  1  pint  water, 
and  sugar;  to  2  cups  add  1  pint  lemon  juice,  1  pint  water, 
and  sugar;  let  each  part  become  jellylike  in  consistency; 
put  in  pans  in  layers;  when  thoroughly  set,  slice  and 
serve. 

Orange  Pudding  (45  Servings). 

Mix  juice  of  24  oranges,  juice  of  4  lemons,  and  4  cups 
sugar;  add  16  egg  yolks  beaten;  add  14  cup  cornstarch; 
cook  in  double  boiler  until  it  begins  to  thicken;  add  3 
tablespoons  gelatin  that  has  been  soaked  in  I/2  cup  cold 
water  and  dissolved  in  I/2  cup  boiling  water ;  when  it  be- 
gins to  thicken,  add  egg  whites  beaten  stiff. 

Peach  Melba. 

Place  in  bottom  of  dish  1/2  of  a  preserved  peach ;  cover 
with  layer  of  ice  cream,  laying  the  other  half  of  the  peach 
on  top;  cap  with  1  spoon  whipped  cream;  pour  over  1 
tablespoon  peach  syrup ;  garnish  with  crystal  cherries. 

Baked  Pears. 

No.  1. 
Wash  and  core  pears;  put  pieces  of  candied  or  pre- 
served ginger  in  centers ;  sprinkle  generously  with  brown 
sugar;  put  enough  water  in  the  pan  to  make  a  good 
syrup ;  bake  forty-five  minutes. 


Some  Selected  Recipes  for  the  Hospital.  189 

No.  2. 
Instead  of  using  ginger,  stick  several  cloves  into  each 
pear. 

Wine  Jelly  (80  to  85  Servings). 

Soak  12  tablespoons  or  6  envelopes  gelatin  in  3  cups 
cold  water;  21/2  quarts  boiling  water;  dissolve  gelatin;  2 
quarts  sugar,  3  cups  sherry,  3  cups  orange  juice,  II/2  cups 
lemon  juice. 

BREADS. 

Bread,  White  (1  Loaf). 

With  milk — Protein,  47  grams;  fat,  18  grams;  carbohy- 
drates, 286  grams;  calories,  1,489. 

Take  1  cup  water  or  milk  which  has  been  boiled,  1  tea- 
spoon salt,  1  teaspoon  sugar,  1  teaspoon  butter  or  lard, 
14  compressed  yeast  cake  dissolved  in  l^  cup  water ;  flour 
to  make  stiff  batter;  add  the  salt  and  sugar  to  the  milk, 
which  has  been  boiled,  while  it  is  still  warm ;  let  cool ;  add 
the  butter  and  the  dissolved  yeast  cake;  beat  in  enough 
flour  to  make  stiff  batter ;  let  rise  until  the  surface  is  cov- 
ered with  bubbles ;  add  flour  to  make  stiff  dough ;  let  rise 
again ;  shape  into  loaves,  handling  as  little  as  possible ;  let 
rise  until  it  doubles  its  bulk ;  bake  in  hot  oven. 

Luncheon  Rolls. 

Protein,  182  grams ;  fat,  230  grams ;  carbohydrates,  1,024 

grams ;  calories,  6,949. 

Take  3  cups  milk;  add  to  milk  when  removed  from 
flame  %  cup  sugar,  II/2  teaspoons  salt,  %  cup  butter;  3 
cakes  compressed  yeast  dissolved  in  %  cup  tepid  water; 
flour  to  make  stiff  batter ;  let  rise ;  add  6  eggs  and  grate 
rind  of  1  lemon;  knead  stiff;  let  rise  again;  shape  into 
finger  rolls  or  round  rolls  and  bake. 


190  Modern  Dietetics. 

Parker  House  Rolls. 

Protein,  47  grams;  fat,  43  grams;  carbohydrates,  316 

grams;  calories,  1,847. 

Set  sponge  as  for  bread,  using  all  milk  instead  of  water ; 
after  sponge  has  risen,  add  2  tablespoons  butter  melted 
and  2  tablespoons  sugar ;  add  flour  enough  to  knead ;  when 
kneaded  enough,  roll  the  dough  to  1/2  i^ich  thickness ;  cut 
with  a  large-sized  cooky  cutter;  indent  a  little  with  back 
of  case  knife  above  the  center;  butter  one  side  and  fold 
over  the  other  side;  let  rise  again  and  bake  in  hot  oven 
twenty  to  twenty-five  minutes. 

Shamrock  Rolls. 

Same  as  Parker  House  Rolls. 
Use  the  same  mixture  as  for  Parker  House  rolls ;  after 
dough  has  been  kneaded,  roll  into  balls  %  inch  in  diame- 
ter; put  3  balls  together  in  a  muffin  pan;  let  rise  until 
light  and  bake  in  hot  oven. 

Swedish  Rolls. 

Protein,  99  grams;  fat,  46  grams;  carbohydrates,  428 

grams ;  calories,  2,326. 
Use  the  same  recipe  as  for  Parker  House  rolls ;  roll  to 
14  inch  thickness;  spread  with  melted  butter,  2  table- 
spoons sugar,  %  teaspoon  cinnamon,  %  cup  stoned  raisins 
chopped,  2  tablespoons  chopped  citron;  roll  mixture  like 
jelly  roll;  cut  into  %-inch  pieces;  put  close  together  in 
buttered  pan,  flat  side  down ;  let  rise  until  very  light  and 
bake  in  hot  oven  twenty  minutes. 

Hot  Cross  Buns. 

Protein,  62  grams;  fat,  53  grams;  carbohydrates,  593 

grams;  calories,  3,111. 
Take  1  cup  scalded  milk,  l^  cup  sugar,  2  tablespoons 
butter,  1/2  teaspoon  salt,  i/^  yeast  cake  dissolved  in  l^  cup 


Some  Selected  Recipes  for  the  Hospital.  191 

warm  water,  %  teaspoon  cinnamon,  3  cups  flour,  1  egg 
well  beaten,  1  cup  raisins,  1  cup  currants ;  set  sponge  as 
for  bread,  and,  when  risen,  add  egg,  spice,  and  fruit,  rest 
of  flour,  and  let  rise  second  time  overnight;  knead  in 
morning ;  keep  it  very  soft,  form  into  biscuit  shapes,  place 
close  together  in  pans ;  let  rise  until  light  and  bake  about 
twenty  minutes  in  hot  oven;  before  they  go  into  oven 
make  a  cross  on  them ;  brush  surface  with  milk. 

Brown  Bread. 

Protein,  53  grams;  fat,  53  grams;  carbohydrates,  293 

grams;  calories,  1,860. 

Take  1  cup  sour  milk,  1/2  cup  molasses,  1  teaspoon  soda, 
1/^  teaspoon  salt,  214  cups  graham  flour,  14  cup  English 
walnuts  (if  desired)  ;  mix  salt,  sour  milk,  soda,  and 
molasses ;  add  flour  and  nuts ;  bake  about  one  hour.  This 
makes  two  small  loaves.  Baking  powder  cans  (1-pound) 
are  good  for  baking  it. 

Boston  Brown  Bread. 

Protein,  7  grams ;  fat,  3  grams ;  carbohydrates,  55  grams ; 

calories,  279. 
Take  2  tablespoons  rye  flour,  2  tablespoons  graham  flour, 
2  tablespoons  cornmeal,  1/0  teaspoon  baking  powder  or 
3-16  teaspoon  soda  if  sour  milk  is  used,  1-16  teaspoon  salt, 
1  tablespoon  molasses,  l^  cup  milk  (sweet  or  sour)  ;  mix, 
but  do  not  sift  dry  ingredients;  add  dry  ingredients  to 
liquid;  place  in  well-buttered  pan  and  steam  two  hours; 
place  in  oven  flfteen  minutes  to  dry  out. 

Muffins  (50  Muffins). 

Protein,  287  grams ;  fat,  364  grams ;  carbohydrates,  1,641 
grams;  calories,  111,439. 

Mix  and  sift  4  quarts  flour,  10%  tablespoons  baking 
powder,  4  teaspoons  salt,  1  cup  sugar;  2  quarts  milk,  1 


192  Modern  Dietetics. 

cup  melted  butter,  8  eggs;  add  gradually  milk,  eggs  (well 
beaten),  and  melted  butter;  bake  twenty-five  minutes. 

Com  Muffins. 

Protein,  43  grams;  fat,  46  grams;  carbohydrates,  350 

grams;  calories,  1,995. 

Take  1  cup  white  flour,  1  cup  commeal,  II/2  teaspoons 
cream  of  tartar,  1  teaspoon  soda,  1  egg,  2  tablespoons  but- 
ter, 1/2  teaspoon  salt,  1/2  cup  sugar,  1  cup  warm  milk ;  mix 
and  sift  the  flour,  commeal,  soda,  and  cream  of  tartar; 
beat  the  egg  and  add  sugar  to  it ;  melt  the  butter  in  the 
milk  and  add  to  the  egg ;  add  the  first  mixture  to  the  sec- 
ond, adding  milk  and  butter  last ;  put  into  buttered  muf- 
fin pans  and  bake  in  hot  oven  fifteen  to  twenty  minutes. 

Pope  vers  (12). 

Protein,  44  grams;  fat,  36  grams;  carbohydrates,  102 

grams;  calories,  874. 

Take  1  cup  flour,  1  cup  milk;  mix  2  eggs  and  1  table- 
spoon butter;  add  flour  and  milk  alternately,  beating  the 
mixture;    bake    in    hot    oven    thirty-five    to    forty-five 

minutes. 

Fritters. 

Protein,  113  grams;  fat,  45  grams;  carbohydrates,  593 

grams ;  calories,  3,238. 

Take  3  eggs,  2  tablespoons  sugar,  1  pint  sour  milk,  1 
teaspoon  soda,  salt,  flour  to  make  stiff  batter;  beat  eggs 
until  light;  add  sugar,  salt,  milk,  flour,  and  soda.  Corn, 
rice,  or  bananas  may  be  added  to  this  batter,  or  they  may 
be  served  plain  with  sauce. 

Sauce  for  Fritters. 

Take  1/2  teaspoon  cornstarch,  1/2  cup  cold  water;  cook 
until  clear;  add  1  cup  crushed  fruit,  jam,  or  marmalade. 


Some  Selected  Recipes  for  the  Hospital.  193 

SANDWICHES. 

Sandwiches  may  serve  a  very  good  purpose  in  supply- 
ing the  extra  nourishment  required  for  patients  on  a 
house  diet,  and  they  also  make  a  most  acceptable  change 
for  the  nurses  for  supper  on  Sunday  nights  or  holidays. 

To  make  dainty  sandwiches,  the  bread  should  be  cut 
thin  and  the  crusts  removed,  and  the  butter  should  be 
creamed  and  spread  on  the  bread  before  cutting  from  the 
loaf.  Bread  should  be  at  least  one  day  old.  If  sandwiches 
are  wrapped  well  in  waxed  paper,  they  will  keep  fresh  and 
moist  for  a  half  day  or  more. 

Cheese  sandwiches  may  be  made  in  a  great  variety  of 
ways,  and  they  have  high  food  value. 

Cheese  Sandwiches. 

No.  1. 
Neufchatel  or  cream  cheese  may  be  mashed  and  moist- 
ened with  salad  dressing,  and  mixed  with  chopped  pimen- 
to, or  olives,  or  nuts.    These  are  especially  good  when 
served  with  brown  bread.     They  may  also  be  made  of  salt 

wafers  or  zephyrettes. 

No.  2. 

Zephyrettes  sprinkled  with  grated  American  or  Swiss 
cheese,  seasoned  with  cayenne ;  put  under  a  flame  and  melt 

the  cheese. 

No.  3. 

Cream  cheese  mixed  with  orange  marmalade  and 
chopped  pecan  nuts.  These  may  also  be  served  on 
crackers,  or  they  make  a  very  dainty  sandwich  if  made 
of  bread  cut  very  thin  and  rolled. 

No.  4. 
Cream  cheese  moistened  with  salad  dressing,  mixed 
with  finely  chopped  pimento,  put  between  a  slice  of  white 
and  a  slice  of  rye  bread. 


194  Modern  Dietetics. 

No.  5. 
Cream  cheese  mixed  to  a  paste  with  sherry  and  spread 
upon  whole  wheat  bread. 

No.  6. 
Mash  Swiss  or  American  cheese  with  the  yolks  of  hard- 
cooked  eggs;  chop  the  whites  and  season  with  salt,  mus- 
tard, salad  dressing,  and  1  teaspoon  chopped  capers ;  use 
graham,  whole  wheat,  or  rye  bread. 

Fruit  Sandwiches. 

No.  1. 
French  prunes,  cut  small,  and  mixed  with  nuts  and 
cream. 

No.  2. 

Candied  cherries  chopped  and  moistened  with  orange 
juice.  These  are  particularly  appetizing  made  with 
crackers  and  a  cherry  placed  on  top. 

No.  3. 
Cook  dates  and  remove  seeds;  mash  or  cut  the  dates; 
add  lemon  juice.     These  make  very  good  sandwiches,  but, 
if  one  desires,  chopped  nuts  may  be  added.     Peanuts  and 
dates  are  a  very  good  combination. 

No.  4. 
Figs  may  be  cooked  and  served  in  the  same  way  as  are 
dates  in  No.  3. 

No.  5. 

Chopped  pecans  and  apricot  jam  may  be  used,  with 
either  white  or  brown  bread. 

No.  6. 
Wash  raisins  and  cut  into  small  pieces ;  mix  with  finely 
chopped  preserved  ginger  and  nuts.     These  may  be  served 
with  either  white  or  brown  bread. 


Some  Selected  Recipes  for  the  Hospital.  195 

Club  Sandwiches. 

These  are  popular  for  supper  for  private  patients,  and 
are  neither  more  expensive  nor  more  difficult  to  prepare 
than  broiled  steaks  or  chops.  Lay  a  piece  of  chicken  on 
a  piece  of  toast,  put  slices  of  bacon  across  the  chicken, 
cover  with  a  crisp  lettuce  leaf  and  plenty  of  salad  dress- 
ing ;  put  another  slice  of  toast  on  top  and  trim  the  edges ; 
if  slices  of  toast  are  very  large,  cut  the  sandwich  into 
halves. 

Chicken  Sandwiches. 

Cut  chicken  into  small  pieces  and  mix  with  chopped 
olives  and  celery,  or  pickles,  or  pimentoes ;  nuts  may  be 
added  if  desired ;  mix  with  mayonnaise. 

Sardine  Sandwiches. 

Remove  skin  and  bones  from  sardines ;  mash  to  a  paste ; 
add  equal  quantity  of  mashed  or  strained  yolk  of  egg 
which  has  been  hard-cooked;  season  with  salt,  cayenne, 
and  lemon  juice. 

CANAPES. 

Canapes  are  prepared  by  cutting  bread  about  I/2  inch 
thick  and  cutting  into  circles  or  squares.  The  bread  is 
then  toasted  or  fried  in  deep  fat  or  browned  in  the  oven. 
It  may  then  be  covered  with  a  mixture  of  "egg,  cheese,  fish, 
or  meat,  separately  or  in  combination.  Canapes  may  be 
served  hot  or  cold,  and  are  often  served  for  one  of  the 
first  courses  at  a  formal  dinner. 

Sardine  Canapes. 

Spread  circular  pieces  of  toast  with  sardines  from  which 
the  bones  have  been  removed ;  rub  to  a  paste  with  a  small 
amount  of  butter  a  few  grains  cayenne  and  a  few  drops 
Worcestershire  sauce  and  lemon  juice;  in  the  center  of 


196  Modern  Dietetics. 

each  canape  place  a  stuffed  olive.  The  whites  of  eggs 
chopped  fine  and  arranged  in  a  border  around  the  edge 
add  to  the  attractiveness  of  the  canape. 

Ham  Canapes. 

Chopped  ham  served  on  toast,  with  sauce  poured  over 
it.    Figaro  sauce  is  most  desirable  served  on  these. 

Figaro  sauce  is  made  by  adding  to  Hollandaise  sauce  2 
tablespoons  tomato  puree  (tomatoes  stewed,  strained,  and 
cooked  until  reduced  to  a  thick  pulp),  1  teaspoon  finely 
chopped  parsley,  and  a  few  grains  cayenne. 

Anchovy  Canapes. 

Spread  canapes  with  anchovy  paste;  chop  separately 
white  and  yolk  of  one  egg  hard-cooked,  and  arrange 
alternately  on  circle;  sections  divided  by  sliced  olives  or 
pimentoes. 

CAKES. 
Almond  Cookies  (Diabetic). 

Protein,  153  grams;  fat,  363  grams;  carbohydrates,  93 

grams;  calories,  4,247. 

Take  6  eggs,  3  tablespoons  butter,  3  cups  almonds 
(blanched  and  ground  3  times),  8  teaspoons  glycerin,  IV2 
teaspoons  vanilla  extract. 

Icing. 

Take  1  egg,  3  saccharin  pellets  if  saccharin  is  desired. 

Boston  Cookies  (100  Small). 

Protein,  93  grams;  fat,  306  grams;  carbohydrates,  798 

grams;  calories,  6,250. 

Take  1  cup  butter,  creamed;  add  gradually  li/^  cups 
sugar  to  butter,  3  eggs  well  beaten ;  add  1  teaspoon  soda 
dissolved  in  II/2  tablespoons  hot  water;  3^4  cups  flour,  and 


Some  Selected  Recipes  for  the  Hospital.  197 

mix  and  sift  with  half  the  flour  I/2  teaspoon  salt,  1  tea- 
spoon cinnamon;  add  to  batter  1/2  cup  raisins  (seeded 
and  chopped),  1  cup  nuts  (chopped),  1/2  cup  currants; 
add  rest  of  flour. 

Fruit  Cookies  (72  Cookies). 

Protein,  307  grams ;  fat,  927  grams ;  carbohydrates,  2,909 
grams;  calories,  20,982. 

Take  6  cups  light-brown  sugar,  3  cups  butter  or  lard 
(or  mixture  of  both),  6  eggs,  2  cups  sour  cream  or  sour 
milk,  6  teaspoons  cinnamon,  3  teaspoons  cloves,  3  tea- 
spoons nutmeg,  3  teaspoons  soda,  6  cups  chopped  raisins 
and  nuts,  12  cups  flour ;  mix  ingredients  in  the  order  given ; 
do  not  mix  very  stiff ;  bake  in  moderate  oven. 

Sponge  Drops. 

Protein,  19  grams;  fat,  13  grams;  carbohydrates,  247 

grams;  calories,  1,188. 

Take  1  whole  egg  and  1  egg  yolk,  beaten  until  light; 
gradually  beat  in  %  cup  sugar,  grating  of  lemon  rind,  14 
cup  cold  water ;  sift  %  cup  flour,  14  teaspoon  soda,  1  tea- 
spoon cream  of  tartar ;  add  dry  ingredients  to  liquid ;  drop 
on  buttered  paper  and  bake  in  hot  oven. 

Devil's  Food  Cake  (80  Servings). 

Protein,  288  grams ;  fat,  610  grams ;  carbohydrates,  2,673 
grams ;  calories,  17,490. 

Take  4  cups  light-brown  sugar,  3  cups  grated  chocolate 
or  cocoa,  2  cups  sweet  milk ;  mix,  cook  until  all  is  dissolved 
and  let  cool;  then  take  4  cups  light-brown  sugar  and  2 
cups  butter  (cream  well),  and  add  8  eggs  and  2  cups 
sweet  milk ;  4  teaspoons  vanilla,  4  teaspoons  soda,  8  cups 
flour ;  beat  well ;  add  flour  and  soda  sifted  together ;  add 
first  mixture. 


198  Modern  Dietetics. 

Sunshine  Cake. 

Protein,  79  grams;  fat,  61  grams;  carbohydrates,  330 

grams;  calories,  2,213. 

Take  10  egg  whites,  10  egg  yolks,  1  cup  flour,  1  cup 
sugar,  1  teaspoon  cream  of  tartar,  1  teaspoon  lemon  juice; 
beat  egg  whites  until  dry  and  stiff;  add  thickly  beaten 
yolks  and  continue  beating;  add  sifted  sugar,  continuing 
beating;  fold  in  flour,  sifted  with  cream  of  tartar;  bake 
in  unbuttered  pan  in  moderate  oven  for  forty-five  minutes. 

Sponge  Cake. 

Protein,  222  grams ;  fat,  108  grams ;  carbohydrates,  2,728 
grams ;  calories,  12,813. 

Take  16  eggs  (beaten  separately),  8  cups  sugar,  9  cups 
flour,  8  teaspoons  baking  powder,  4  cups  hot  water,  4  tea- 
spoons vanilla ;  beat  yolks  of  eggs ;  add  sugar,  a  little  at 
a  time ;  add  whites,  beaten  dry,  and  then  hot  water ;  sift 
flour  and  baking  powder  together  and  add  last. 

Sour  Cream  Cookies  (100  Cookies). 

Protein,  130  grams ;  fat,  406  grams ;  carbohydrates,  1,365 

grams ;  calories,  9,803. 

Take  4  eggs  (slightly  beaten),  3  cups  sugar,  II/2  cups 
butter,  11/^  cups  sour  cream,  1  teaspoon  cinnamon,  1  tea- 
spoon nutmeg,  I/2  teaspoon  cloves;  2  teaspoons  soda,  7 
cups  flour,  1  teaspoon  baking  powder,  sifted  together ;  salt. 

Oatmeal  Cookies  (100  Cookies). 

Protein,  192  grams ;  fat,  635  grams ;  carbohydrates,  1,595 
grams;  calories,  12,877. 

Take  5  eggs,  21/2  cups  brown  sugar  and  2I/2  cups  butter 
or  butter  and  lard  (creamed),  1  cup  sour  cream;  sift 
together  5  cups  flour,  5  cups  oatmeal,  21/2  teaspoons  soda, 
21/2  teaspoons  cinnamon ;  add  2  to  214  cups  raisins. 


Some  Selected  Recipes  for  the  Hospital.  199 

Ice  Cream  Cake  (4  Cakes). 

Protein,  185  grams;  fat,  435  grams;  carbohydrates,  1,433 
grams;  calories,  10,626. 
Take  4  cups  sugar  and  2  cups  butter  (cream  well),  2 
cups  milk;  sift  together  4  cups  flour,  1  cup  cornstarch, 
7  teaspoons  baking  powder ;  4  teaspoons  flavoring,  24  egg 
whites  beaten  stiff ;  fold  in  last. 

Fudge  Cake  (24  Pieces). 

Protein,  387  grams ;  fat,  110  grams ;  carbohydrates,  585 

grams ;  calories,  4,875. 
Take  IV^  cups  sugar,  5  tablespoons  cocoa,  %  cup  butter, 
2  eggs,  2  teaspoons  salt,  %  teaspoon  soda,  %  cup  sour 
milk,  2l^  cups  flour,  %  cup  hot  water,  2  teaspoons  vanilla ; 
cream  butter,  sugar,  and  cocoa  together;  add  eggs  and 
beat  well ;  sift  flour  with  salt  and  soda,  and  add  alternately 
with  sour  milk  to  cake  mixture;  stir  in  hot  water  and 
vanilla ;  beat ;  bake  in  flat  pan,  lined  with  oil  paper,  in  mod- 
erate oven. 

Gold  Cake  (36  Cup  Cakes). 

Protein,  97  grams;  fat,  211  grams;  carbohydrates,  761 

grams;  calories,  5,419. 
Take  2  cups  sugar,  1/2  cup  butter,  1  cup  milk,  16  egg 
yolks,  3  cups  flour,  5  teaspoons  baking  powder,  li/i  tea- 
spoons flavoring,  1  teaspoon  salt ;  cream  butter ;  add  sugar 
and  salt ;  add  well-beaten  egg  yolks ;  add  milk  alternately 
with  flour  and  baking  powder. 

Sour  Cream  Cake. 

Protein,  101  grams;  fat,  121  grams;  carbohydrates,  828 

grams;  calories,  4,819. 
Take  4  cups  flour,  2  cups  sugar,  1  teaspoon  soda,  2  tea- 
spoons cinnamon,  2  teaspoons  nutmeg,  1  teaspoon  salt,  2 


200  Modem  Dietetics. 

cups  sour  cream,  4  eggs ;  sift  flour,  soda,  spices,  and  salt 
together;  place  in  bowl  and  add  sugar,  cream,  and  yolks 
of  eggs  beaten  thoroughly;  add  whites  beaten  stiff;  mix 
quickly  and  bake  in  hot  oven. 

Peanut  Wafers  (24  Wafers). 

Protein,  143  grams;  fat,  70  grams;  carbohydrates,  174 

grams;  calories,  1,511. 
Take  2  tablespoons  butter,  l^  cup  sugar,  1  egg,  1/2  cup 
flour,  1  teaspoon  baking  powder,  14  teaspoon  salt,  2  table- 
spoons milk,  1/2  cup  finely  chopped  peanuts ;  cream  butter 
and  add  gradually,  while  beating  constantly,  the  sugar; 
add  well-beaten  egg;  mix  and  sift  flour,  baking  powder, 
and  salt;  add  to  first  mixture;  add  milk  and  nuts;  drop 
from  teaspoon  on  an  unbuttered  sheet  1  inch  apart,  V^ 
peanut  on  each ;  bake  in  moderate  oven  twelve  to  fifteen 
minutes. 

Chocolate  Chips. 

Protein,  104  grams ;  fat,  429  grams ;  carbohydrates,  1,047 

grams;  calories,  8,617. 

Take  li/^  cups  butter,  3  cups  sugar,  6  eggs,  6  squares 
chocolate,  14  teaspoon  salt,  a  few  drops  vanilla,  3  cups 
flour;  cream  butter  and  sugar;  add  eggs  well  beaten  and 
melted  chocolate ;  add  dry  ingredients  last ;  spread  in  thin 
layer  on  bottom  of  pan ;  bake  ten  to  twenty  minutes ;  cut 
into  finger  lengths  while  hot. 

BEVERAGES. 

Cocoa  (6  Servings). 

Mix  3  tablespoons  cocoa,  3  tablespoons  sugar,  I/2  tea- 
spoon salt;  add  2  cups  water;  cook  in  double  boiler  not 
less  than  one-half  hour,  or  boil  ten  minutes ;  add  3  cups 
hot  milk;  mill.  Serve  with  marshmallows  or  whipped 
cream. 


Some  Selected  Recipes  for  the  Hospital.  201 

Grape  Punch  (35  to  40  Punch  Glasses). 

Mix  1  quart  grape  juice,  1  cup  sugar,  juice  of  4  lemons, 
juice  of  6  oranges;  when  sugar  is  dissolved,  add  1  quart 
water ;  chill.     Serve  with  sprig  of  mint. 

Sangaree. 

Take  juice  of  2  lemons,  3  oranges,  1  pineapple,  1  cup 
powdered  sugar,  1  cup  cherries  or  grapes  (cut  into 
halves) ;  shaved  ice  and  water  as  desired. 

Mint  Sangaree. 

Crush  2  or  3  sprays  mint  with  sugar;  put  into  glass 
half  full  of  cracked  ice;  add  4  tablespoons  grape  juice;  fill 
glass  with  charged  water. 

Summer  Zephyr  (50  Servings). 

Take  II/2  pounds  rhubarb,  cut  into  thin  slices;  cover 
with  water ;  add  1  stick  cinnamon,  1  bay  leaf ;  cook  until 
tender;  strain;  add  1  cup  sugar;  simmer  about  ten 
minutes;  add  1  pint  orange  juice,  juice  of  3  lemons,  1/2 
cup  preserved  ginger;  cool.  Serve  in  tall  glasses  with 
shaved  ice. 

Syllabub  (8  Servings). 

Take  1/2  pound  sugar,  1  quart  lukewarm  cream,  1  glass 
wine ;  dissolve  sugar  in  wine,  and  pour  on  cream  slowly, 
holding  pitcher  high  above  wine  so  as  to  make  mixture 
froth. 

Tea  Punch  (35  to  40  Punch  Glasses). 

Take  (1)1  quart  water  and  1  cup  sugar  and  boil  fifteen 
minutes;  then  take  (2)  3  cups  boiling  water  and  6  tea- 
spoons black  tea  and  steep  five  minutes ;  strain  2  into  1 ; 
chill ;  then  take  (3)  grated  rind  of  1  orange  and  2  lemons ; 
cover  with  sugar;  let  stand  one  to  two  hours;  add  juice 


202  Modern  Dietetics. 

and  14  cup  claret  or  port ;  strain  3  through  cheese  cloth ; 
mix  all.    Serve  cold. 

Imperial  Drink. 

Take  1  dram  tartaric  acid  to  1  pint  water,  lemon  juice 
to  flavor,  sugar. 

Modified  Buttermilk. 

Take  1  quart  buttermilk,  1  even  tablespoon  rice;  heat 
the  mixture  over  a  small  gas  flame;  stir  constantly  until 
it  has  boiled  up  three  times ;  add  2  tablespoons  sugar  and 
strain. 


INDEX 


Acid,  benzoic,  43 

butyric,  29,  30 

capric,  29 

caproic,  29 

citric,  43 

malic,  43 

oleic,  29 

sulphurous,  46 

tannic,  48 

tartaric,  43 
Acidi  lactici,  bacillus,  21 
Acidosis,  75 
Acids,  amino,  17 
Acrolein,  31 
Albumin,  62 
Albuminized  milk,  140 
Alderney  cows,  20 
Algae,  marine,  16 
Alkalies,  18 

Allen  treatment  in  diabetes,  75 
Alligator  pear,  175 

pear  salad,  175 

pear  soup, 175 
Almond  cookies,  diabetic,  196 

soup,  cream  of,  156 
American  cheese,  26 
Amino  acids,  17 
Anchovy  canapes,  196 
Anemia,  75 

secondary,  83 
Angel  custard,  178 

parfait,  179 
Animal  flour,  38 

protein,  16 
Anorexia,  45,  74 
Antiscorbutics,  43 
Apple  meringue,  date  and,  182 

salad  with  cranberries,  172 
Apples,  caramelized,  180 

coddled,  179 

fried,  166 

stuffed,  169 
Arrowroot,  40 
Asparagus  and  eggs,  169 
Atwater  tables  of  food  values, 
151 


Avacado,  45, 175 

dessert,  175 

salad,  175 

soup, 175 
Avocations,  physical,  65 

sedentary,  65 

B 

Bacillus  acidi  lactici,  21 
Bacon,  64 

and  chicken  liver,  163 

liver  and,  163 
Bacteria,  lactic  acid-forming, 

21,  22 
Baked  bananas,  166 

cauliflower,  144 

corn  and  minced  ham,  169 

custard,  145 

macaroni  and  oysters,  160 

pears,  188 

shad, 162 

squab, 166 

squash,  168 
Ball,  meat,  65 

tea,  49 
Bananas,  baked,  166 

sauce  for,  178 
Barley,  39 

gruel,  39 

jelly,  39 

water,  22,  39 
Bavarian  pineapple,  185 

strawberry,  186 
Bean  flour,  soy,  41 

soup,  115 

soup,  cream  of,  117 
Beans,  cocoa,  48 

kidney,  41 

lima,  41 

soy,  41 
Beef,  63 

tea,  65, 142 
Benzidin  diet,  75 

test  diet,  83 
Benzoic  acid,  43 
Bermuda  onions,  35 
Bernaise  sauce,  177 


203 


204 


Index. 


Beverages,  200 
Bicarbonate,  sodium,  ^l 
Birds,  veal,  164 
Black  coffee,  50 
Boiled  heart,  163 
salad  dressing,  17b 

Boston  brown  bread,  191 

cookies,  196 
Boudins,  159 
Bouillon  cubes,  61 

tomato,  158 
Brain  food,  fish  as,  67 
Bran  bread,  85 
muffins,  145 
Brazilian  salad,  17Z 
Bread,  bran,  85 
Boston  brown,  191 
brown,  191 
white,  189 
Breads,  189 
Breakfast  foods,  37 
foods,  predigested,  4U 

test,  76 
Broiled  chicken,  165 

squab, 166 
Broth,  veal,  64 

Brown  bread,  191 

bread,  Boston,  191 
Buckingham,  eggs  a  la,  1  /u 
Building  up  process,  41 
Buns,  hot  cross,  19U 
Butter,  15, 25 

rancid,  28 

renovating,  28 

substitutes  for,  27 

uses  of,  27 
Butterine,29 
Buttermilk,  modified,  20i 
Butyric  acid,  29,  30  ,   . 

Buying,  former  methods  of,  4 

method  in,  6 

supplies    at    Oak    Forest 
firmary,  107 

unit  system  in,  7 


Cabbage,  167 
souffle,  144 
Cafe  au  lait,  50 
Caffein,48  49 
Cake,  devil's  food,  19  i 


Cake — continued. 

fudge,  199 

gold,  199 

ice  cream,  199 

sour  cream,  199 

sponge,  198 

sunshine,  198 
Cakes,  196 
Calcium,  18 
Calf's-foot  jelly,  142 

SS'foodTaiuJs'in,  140 
gE  typhoid,  diet  for  high,  79 

Calves'  tongues,  164 
Camembert  cheese,  Zb 
Canapes,  195 
anchovy,  196 
ham,  196 
sardine,  195 
Candling  eggs,  59 
Canned  fruits,  4d 
Cantaloupe  sundae,  l»u 
Capric  acid,  29 
Caproic  acid,  29 

Caramel  custard,  l«u 
Caramelized  apples,  180 

Carbohydrates,  13, 1  ^  ^-i 

tolerance  for,  72 
Carbonates,  18 
Cardiac  cases,  74 

disease,  diet  for,  /9 

diet,  74 
Carts,  food,  94 
Casein,  21 

of  milk,  17 
Cases,  cardiac,  74 
Caudle,  rice,  142 
Cauliflower,  baked,  144 
Celery  soup,  cream  ot,  lob 
Cellulose,  14 
Cereal  coffee,  50 

gharilfhispitals  feeding,  107 

Charlotte,  coffee,  144 

russe,  180 
Cheddar  cheese,  lb 
Cheese,  25 

American,  26  . 

and  peanut  sandwiches,  l^i 

Camembert,  25 

Cheddar,  25 

cottage,  25 


Index. 


205 


Cheese — continued. 

cream,  25, 173 

Edam,  25 

Gorgonzola,  26 

Gruyere,  26 

Neufchatel,  25 

Parmesan,  26 

Roquefort,  26 

salad,  cottage,  173 

salad,  date  and,  173 

sandwiches,  193 

sandwiches,  cottage,  123 

souffle,  146 

Stilton,  25 
Cherry  sandwich,  194 

sponge,  181 
Chicken,  broiled,  165 

liver,  bacon  and,  163 

salad,  hot,  173 

sandwich,  195 
Chicory,  49 

Children,  feeding  the,  105 
Chips,  chocolate,  200 
Chlorid,  sodium,  18 
Chlorosis,  83 
Chocolate,  48,  51 

chips,  200 

imitation,  52 

sauce,  hot,  178 
Chops,  veal,  en  casserole,  165 
Chowder,  clam,  158 

fish, 162 
Citric  acid,  43 
Civil  service  rules,  109 
Clam  chowder,  158 
Clotted  cream,  28 
Club  sandwiches,  195 
Cocktail,  fruit,  182 

sauce,  oyster,  176 
Cocoa,  48,  51, 118,  200 

beans,  48 

manufacture  of,  51 
Coddled  apples,  179 
Codfish  souffle,  160 
Cod  liver  emulsions,  27 
Coffee,  48 

black,  50 

cereal,  50 

charlotte,  144 

ice  cream,  181 

Java,  49 

jelly,  144 


Coffee — continued. 

Mocha,  49 

Rio,  49 

tannin  in,  49 
Cold  storage,  8,  54 

storage  for  fruits,  45 
Collagen,  16,  62 
Combinations  for  luncheon,  food, 

126 
Commissary  departments,  100 

managing  the  institution,  4 
Common   foods,  composition  of, 

150 
Composition   of   common   foods, 

150 
Constipation,  69 

diet,  84 

fruits  in,  70 
Constituents  of  foods,  13 
Containers,  food,  95,  96 
Contamination,  sewage,  68 
Convalescent  diet,  76,  84 
Cooked  fruits,  43 
Cookies,  diabetic  almond,  196 

Boston,  196 

fruit,  197 

oatmeal,  198 

sour  cream,  198 
Corn   and   minced   ham,    baked, 
169 

muffins,  192 

soup,  cream  of,  156 
Cottage  cheese,  25 

cheese  salad, 173 

cheese  sandwiches,  123 
Cottonseed  oil,  15,  30 
Cows,  Alderney,  20 

Durham.  20 

Holstein,  20 

Jersey, 20 
Cranberries,    apple   salad   with, 

172 
Cranberry  ice,  181 

jelly,  177 
Cream,  20,  27 

cake,  sour,  199 

California,  179 

cheese,  25, 173 

clotted,  28 

cookies,  sour,  198 

dessert,  whipped,  187 

Devonshire,  28 


206 


Index. 


Cream — continued. 

Huntington,  183 

macaroon,  184 

of  almond  soup,  156 

of  bean  soup,  117 

of  celery  soup,  156 

of  corn  soup,  156 

of  pea  soup,  157 

of  potato  soup,  157 

of  spinach  soup,  157 

of  tomato  soup,  116, 158 

puffs,  181 

puffs,  filling  for,  182 

soups,  155 

Spanish,  186 
Croquettes,  salmon,  161 
Cross  buns,  hot,  190 
Cubes,  bouillon,  61 

spiced  jelly,  161 
Curd,  21 
Cured  pork,  64 
Currant  mint  sauce,  177 
Custard,  angel,  178 

baked,  145 

caramel,  180 

D 

Daily  water  for  system,  18 
Date  and  apple  meringue,  182 

and  cheese  salad,  173 

pudding,  steamed,  182 

sandwich,  194 
Departments,  commissary,  100 
Dessert,  avacado,  175 

whipped  cream,  187 
Desserts,  178 
Devil's  food  cake^  197 
Devonshire  cream,  28 
Dextrin,  14 
Dextrose,  14 
Diabetes,  69,  75 

Allen  treatment  in,  75 

diet  for,  80 
Diabetic  almond  cookies,  196 

diet,  75, 143 
Diet,  benzidin,  75 

benzidin  test,  83 

cardiac,  74 

constipation,  84 

containing  high  iron  content, 
83 


Diet — continued. 

convalescent,  76,  84 

diabetic,  75, 143 

Dubois' milk,  74,  78 

eggs  as  a  staple  article  of,  56 

for  cardiac  disease,  79 

for  diabetes,  80 

for  gastric  ulcer,  76 

for  high-calorie  typhoid,  79 

for  hyperacidity,  77 

for  nephritis,  81 

for  subacidity,  78 

high  iron  content,  75 

Lenhartz,  72,  76 

light  soft,  84 

liquid,  76,  83, 140 

nephritis,  75 

purin-free,  75,  82 

Sippey,  73 

soft  with  care,  76 

training  for  nurses,  98 

tuberculosis,  75 

typhoid,  74 
Dietary,  fish  in  the,  67 

oysters  in  the,  67 

vegetables  in  the,  32 
Dietetics  of  the  future,  129 

practice  in  teaching,  135 

principles  of,  131 

theory  in  teaching,  133 

training  school  work  in,  131 
Diets  in  disease,  special,  69 

set  of,  72 

Sherman  on  purin,  82 

special,  71, 140 
Disease,  special  diets  in,  69 

diet  for  cardiac,  79 
Diseases,  metabolic,  69,  70 
Disturbance,  gastric,  65 
Dressing,  boiled  salad,  176 

mayonnaise,  176 
Dressings,  salad,  175 
Dried  fruits,  43 
Drink,  imperial,  202 
Drops,  sponge,  197 
Drying  fruits,  45 
Dubois'  milk  diet,  74,  78 
Duchess  soup,  157 
Duodenal  ulcer,  72 

ulcer,  post- operative  care  of, 
73 
Durham  cows,  20 


Index. 


207 


Dyspepsia,  69 


E 


Edam  cheese,  25 
Egg  in  nest,  171 

sandwiches,  119 

souffle,  171 
Eggplant  straws,  167 

stuffed,  167 
Eggs,  170 

a  la  Buckingham,  170 

a  la  goldenrod,  170 

as  a  staple  article  of  diet,  56 

asparagus  and,  169 

candling,  59 

fertile,  57 

in  tomato,  172 

preserving,  57 

raw  vs.  cooked,  58 

sterile,  57 

stuffed,  146 
Eiweissmilch,  24, 141 
Emulsions,  cod  liver,  27 
En  casserole,  veal  chops,  165 
Energy  requirement,  126 
Enzyme,  21,  44 
Equivalents,  quantity,  140 

weight,  140 
Extracts,  meat,  61,  65 


Fat,  15 
Fats,  17 

tolerance  for,  72 
Feeding  charity  hospitals,  107 

hospital  help,  93 

industrial  workers,  110 

interns,  90 

maternity  patients,  90 

nurses,  90 

surgical  patients,  87 

the  children,  105 

the  insane,  106 

the  private  sanatorium,  108 

the  tuberculous,  104 

various  institutions,  100 
Ferment,  proteolytic,  23 
Fertile  eggs,  57 
Fibrin,  63 
Fig  sandwich,  194 


Filling  for  cream  puffs,  182 
Fish, 159 

as  brain  food,  67 

chowder,  162 

in  the  dietary,  67 

tuna, 162 
Flour,  animal,  38 

graham,  38 

soy  bean,  41 

whole  wheat,  38 
Food  cake,  devil's,  197 

carts,  94 

combinations  for  luncheon, 126 

containers,  95,  96 

fish  as  brain,  67 

poultry  as  a  hospital,  53 

value  of  certain  products,  12, 
19 

values,  Atwater  tables  of,  151 

values  in  calories,  140 
Foods,  breakfast,  37 

composition  of  common,  150 
-^    constituents  of,  13 

for  the  sick,  principal,  147 

nitrogenous,  16 

predigested  breakfast,  40 

principal  foods,  140 
Formaldehyd,  22 
Former  methods  of  buying,  4 
Fresh  pork,  64 
Fried  apples,  166 
Fritters,  192 

sauce  for,  192 
Fruit  cocktail,  182 

cookies,  197 

gelatin,  188 

sandwiches,  194 
Fruits,  canned,  43 

cold  storage  for,  45 

cooked,  43 

dried,  43 

drying,  45 

in  constipation,  70 

raw,  43 
Fudge  cake,  199 
Future,  dietetics  of  the,  129 


Gastric  disturbance,  65 
juice,  17,  22 
ulcer,  diet  for,  76 


208 


Index. 


Gastric — continued. 

ulcer,  post-operative  care  of, 
73 

ulcer,  Sippey  treatment  for,  73 

ulcers,  72 
Gastritis,  75 
Gelatin,  16 

fruit,  188 
Germs,  typhoid,  68 
Gland,  thymus,  65 
Glazed  sweet  potatoes,  168 
Globulin,  63 
Glycerol,  31 
Glycogen,  67 
Glycosuria,  75 
Gold  cake,  199 
Goldenrod,  eggs  a  la,  170 
Gorgonzola  cheese,  26 
Gout,  65,  69 
Graham  flour,  38 
Grape  ice,  182 

punch,  201 
Green  vegetables,  34 
Gruel,  barley,  39 

rice,  142 

Van  Noorden's,  143 
Gruels,  42 
Gruyere  cheese,  26 


H 


Ham,  64 

baked  corn  and  minced,  169 

canapes,  196 

sandwiches,  120 
Hamburg  sponge,  183 
Hard  water,  18 
Hash,  heavenly,  183 
Heart,  boiled,  163 
Heavenly  hash,  183 
Help,  feeding  hospital,  93 

inmate,  110 

in  the  sanatorium  kitchen,  109 
Hemoglobin,  18 
High  calorie  typhoid,  diet  for,  79 

iron  content  diet,  75 

iron   content,  diet   containing, 
83 
HoUandaise  sauce,  145, 177 
Holstein  cows,  20 
Horseradish  sauce,  177 
Hospital  food,  poultry  as  a,  53 


Hospital — continued. 

help,  feeding,  93 

selected  recipes  for  the,  155 
Hospitals,  feeding  charity,  107 
Hot  chicken  salad,  173 

chocolate  sauce,  178 

cross  buns,  190 
Huntington  cream,  183 
Hydrolysis,  18 
Hyperacidity,  72 

diet  for,  77 


Ice,  cranberry,  181 

cream  cake,  199 

cream,  coffee,  181 

cream,  plain,  183 

grape,  182 

lemon,  183 
Icing,  196 

Imitation  chocolate,  52 
Imperfect  peristalsis,  70 
Imperial  drink,  202 
Indigestion,  69 
Individual  treatment,  72 
Industrial  workers,  feeding,  110 
Infirmary,    buying    supplies    at 

Oak  Forest,  107 
Inmate  help,  110 
Inorganic  salts,  16 
Insane,  feeding  the,  106 
Institutions,  feeding  various,  100 
Intestinal  juices,  17 

obstruction,  70 
Interns,  feeding,  90 
Inulin,  36 
Irish  moss,  16 
Iron, 17, 18 

content  diet,  high,  75 
content,  diet  containing  high, 
83 
Italienne,  macaroni  a  la,  170 


Jambolaya,  159 
Jardiniere  salad,  173 
Java  coffee,  49 
Jellied  vegetable,  168 
Jelly,  barley,  39 


Index. 


209 


Jelly — continued. 

calf  s-foot,  142 

coffee,  144 

cranberry,  177 

cubes,  spiced,  161 

salad,  tomato,  143 

tomato,  174 

wine,  144, 189 
Jersey  cows,  20 
Judging  poultry,  53 
Juice,  gastric,  17,  22 
Juices,  intestinal,  17 

pancreatic,  17 

K 

Kidney  beans,  41 

Kitchen,  help  in  the  sanatorium, 

109 
Koumiss,  24, 141 


Lactic  acid-forming  bacteria,  21, 

22 
Lactici,  bacillus  acidi, 
Lactose,  24 
Lait,  cafe  au,  50 
Lamb,  64 
Lard,  30 
Laxatives,  43 
Legumes,  37,  40 
Lemonade,  milk,  140 
Lemon  ice,  183 
Lenhartz  diet,  72,  76 
Light  soft  diet,  84 
Lima  beans,  41 
Lime  water,  22 
Liquid  diet,  76,  83, 140 
Liver,  64 

and  bacon,  163 

bacon  and  chicken,  163 
Loaf,  prune,  185 

salmon,  161 
Luncheon,  food  combinations  for, 
126 

rolls,  189 

M 

Macaroni,  39 

a  la  Italienne,  170 


Macaroni — continued. 

and  oysters,  baked,  160 
Macaroon  cream,  184 
Magnesium,  18 
Making  out  menus,  94 
Malic  acid,  43 

Managing   the   institution   com- 
missary, 4 
Manufacture  of  cocoa,  51 
Maple  mousse,  184 

pudding  sauce,  178 
Marine  algae,  16 
Marshmallow  pudding,  184 
Marshmallows,  toasted,  184 
Mashed  potato,  marquise  style, 

168 
Maternity  patients,  feeding,  90 
Mayonnaise  dressing,  176 
Meat  ball,  65 

Bernaise  sauce  for,  177 

extracts,  61,  65 

protein,  65 

pulp,  65 

ripening  of,  63 
Meats,  163 

and  vegetables  combined,  169 

preparation  of,  61 

storage  of,  61 
Melba,  peach,  188 
Menus,  making  out,  94 

routine,  88 
Meringue,  date  and  apple,  182 
Metabolic  diseases,  69,  70 
Metabolism,  principles  of,  131 
Method  in  buying,  6 
Microorganisms,  putrefactive, 

21 
Milk,  albuminized,  140 

and  its  modifications,  20 

casein  of,  17 

diet,  Dubois',  74,  78 

lemonade,  140 

pasteurizing,  23 

peptonizing,  23 

sherbet,  187 

skimmed,  21 

sour,  21,  22 

sterilizing,  23 
Minced  ham,  baked  com  and,  169 
Mineral  salts,  17 
Mint  salad,  orange  and,  173 

sangaree,  201 


210 


Index. 


Mint — continued. 

sauce,  currant,  177 
Mocha  coffee,  49 
Mock  terrapin,  160 
Modifications,  milk  and  its,  20 
Modified  buttermilk,  202 
Moss,  Irish,  16 
Mousse,  maple,  184 
Muffins,  191 

bran, 145 

corn,  192 
Mulligatawny  soup,  158 
Mutton,  64 
Myosin,  63 

N 

Neapolitan  pudding,  188 
Nephritis  diet,  75 
Nest,  egg  in,  171 
Neufchatel  cheese,  25 
Nitrogenous  foods,  16 
Noodles,  39 
Nucleoprotein,  65 
Nurses,  diet  training  for,  98 

feeding,  90 
Nutritive  ratio,  126 

O 

Oak    Forest    Infirmary,    buying 

supplies  at,  107 
Oatmeal  cookies,  198 
Obesity,  69 

Obstruction,  intestinal,  70 
Oil,  cottonseed,  15,  30 

olive,  15,  30 

peanut,  31 

sesame,  31 
Oleic  acid,  29 
Oleomargarine,  29 
Olive  oil,  15,  30 
Olives,    tomatoes    stuffed    with 

ripe,  168 
Omelet,  171 
Onions,  Bermuda,  35 

Spanish,  35 
Orange  and  mint  salad,  173 

pudding,  188 

sauce,  178 
Oyster  cocktail  sauce,  176 
Oysters,baked  macaroni  and,  160 


Oysters — continued, 
in  the  dietary,  67 
raw,  67 


Palmitin,  30 
Pancreatic  juices,  17 
Pantries,  serving,  97 
Parfait,  angel,  179 
Parker  House  rolls,  190 
Parmesan  cheese,  26 
Pasteurizing  milk,  23 
Patients,  feeding  maternity,  90 

feeding  surgical,  87 

special  orders  for,  88 

whims  of  private,  89 
Peach  melba,  188 

salad,  174 
Peanut,  41 

oil,  31 

sandwiches,  cheese  and,  121 

wafers,  200 
Pear,  alligator,  175 

salad,  alligator,  175 

soup,  alligator,  175 
Pears,  baked,  188 
Peas,  168 
Pea  soup,  cream  of,  157 

soup,  split,  112 
Pecan  salad,  174 

sandwich,  194 
Pectin,  43 

PGCtOS6    43 

Peppers,  stuffed,  169, 174 
Pepsin,  17 
Peptones,  17 
Peptonizing  milk,  23 
Per  capita  ration,  103, 107 
Peristalsis,  imperfect,  70 
Phosphorus,  18 
Physical  avocations,  65 
Pineapple,  Bavarian,  185 

pudding,  185 
Piquante,  sauce,  164 
Plain  ice  cream,  183 
Popovers,  192 
Pork,  cured,  64 

fresh,  64 

sausage,  39 
Post-operative  care  of  duodenal 
ulcer,  73 


Index. 


211 


Post-operative — continued. 

care  of  gastric  ulcer,  73 
Potassium,  18 

Potato,  mashed,  marquise  style, 
168 

sandwiches,  sweet,  124 

soup, 114 

soup,  cream  of,  157 
Potatoes,  glazed  sweet,  168 
Poultry,  159 

as  a  hospital  food,  53 

judging,  53 
Practice  in  teaching  dietetics, 

135 
Predigested  breakfast  foods,  40 
Preparation  of  meats,  61 
Preserving  eggs,  57 
Principal  foods,  140 

foods  for  the  sick,  147 
Principles  of  dietetics,  131 

of  metabolism,  131 
Private  patients,  whims  of,  89 

sanatorium,  feeding  the,  108 
Process,  building  up,  4 
Protein,  animal,  16 

vegetable,  16 
Proteins,  17,  37,  65 

tolerance  for,  72 
Proteolytic  ferment,  23 
Proteoses,  17 
Prune  loaf,  185 

sandwich,  194 

whip,  185 
Ptomaines,  67 
Pudding,  marshmallow,  184 

Neapolitan,  188 

orange,  188 

pineapple,  185 

sauce,  maple,  178 

snow,  145 

spinach, 146 

steamed  date,  182 
Puddings,  sauces  for,  178 
Puffs,  cream,  181 

cream,  filling  for,  182 
Pulp  meat,  65 
Punch,  grape,  201 

tea, 201 
Purin  diets,  Sherman  on,  82 

free  diet,  75,  82 
Putrefactive  microorganisms,  21 


Q 

Quail,  roasted,  159 
Quantity  equivalents,  140 

R 

Raisin  sandwich,  194 

sauce,  163 
Rancid  butter,  28 
Rarebit,  Welsh,  26 
Raspberry  sauce,  187 
Ratio,  nutritive,  126 
Ration,  per  capita,  103, 107 
Raw  fruits,  43 

oysters,  67 

vs.  cooked  eggs,  58 
Recipes  for  the  hospital,   se- 
lected, 155 
Rennet,  21 
Rennin,  21 

Renovating  butter,  29 
Requirement,  energy,  126 
Rice  caudle,  142 

gruel,  142 

surprise,  186 

unpolished,  40 
Rio  coffee,  49 
Ripening  of  meat,  63 
Roasted  quail,  159 
Rolls,  luncheon,  189 

Parker  House,  190 

shami'ock,  190 

Swedish,  190 
Roquefort  cheese,  26 
Roselle,  45 
Routine  menus,  88 
Rules,  civil  service,  109 
Russe,  charlotte,  180 


Sago,  40 

Salad,  alligator  pear,  175 

apple,  with  cranberries,  172 

avacado,  175 

Brazilian,  172 

cottage  cheese,  173 

date  and  cheese,  173 

dressing,  boiled,  176 

dressings,  175 

hot  chicken,  173 


212 


Index. 


Salad — continued. 

jardiniere,  173 

orange  and  mint,  173 

peach, 174 

pecan,  174 

sauces,  175 

tomato  jelly,  143 

vegetable,  174 
Salads,  172 
Salmon  croquettes,  161 

loaf,  161 

sandwiches,  122 
Salts,  inorganic,  16 

mineral,  17 
Samovar,  49 

Sanatorium,  feeding  the  private, 
108 

kitchen,  help  in  the,  109 
Sandwich,  cheese,  193 

cheese  and  peanut,  121 

cherry,  194 

chicken, 195 

club,  195 

cottage  cheese,  123 

date,  194 

egg,  119 

fig, 194 

fruit,  194 

ham,  120 

pecan,  194 

prune,  194 

raisin,  194 

salmon,  122 

sardine,  125, 195 

sweet  potato,  124 
Sandwiches,  193 
Sangaree,  201 

mint,  201 
Sardine  canapes,  195 

sandwiches,  125, 195 
Sauce,  Bernaise,  for  meat,  177 

currant  mint,  177 

for  bananas,  178 

for  fritters,  192 

Hollandaise,  145, 177 

horseradish,  177 

hot  chocolate,  178 

maple  pudding,  178 

orange,  178 

oyster  cocktail,  176 

piquante,  164 

raisin,  163 


Sauce — continued, 
raspberry,  187 
tartar,  175 
valentine,  176 
Sauces  for  puddings,  178 

salad,  175 
Sausage,  pork,  39 
School  work  in  dietetics,  train- 
ing, 131 
Secondary  anemia,  83 
Sedentary  avocations,  65 
Selected   recipes  for  the  hospi- 
tal, 155 
Service  rules,  civil,  109 
Serving  pantries,  97 
Sesame  oil,  31 
Set  of  diets,  72 
Sewage  contamination,  68 
Shad,  baked,  162 
Shamrock  rolls,  190 
Sherbet,  milk,  187 
Sherman  on  purin  diets,  82 
Sick,    principal    foods    for    the, 

147 
Sippey  diet,  73 

treatment  for  gastric  ulcer,  73 
Skimmed  milk,  21 
Snow  pudding,  145 
Sodium  bicarbonate,  21 

chlorid,  18 
Soft  with  care  diet,  76 

water,  18 
Souffle,  cabbage,  144 

cheese,  146 

codfish,  160 

egg,  171 
Soup,  alligator  pear,  175 

avacado, 175 

bean, 115 

cream  of  almond,  156 

cream  of  bean,  117 

cream  of  celery,  156 

cream  of  corn,  156 

cream  of  pea,  157 

cream  of  potato,  157 

cream  of  spinach,  157 

cream  of  tomato,  116, 158 

duchess,  157 

mulligatawny,  158 

potato,  114 

split  pea,  112 

vegetable,  113 


Index. 


213 


Soups,  155 

cream,  155 
Sour  cream  cake,  199 

cream  cookies,  198 

milk,  21,  22 
Soy  bean,  41 

bean  flour,  41 
Spaghetti,  39 
Spanish  cream,  186 

onions,  35 
Special  diet,  71, 140 

diets  in  disease,  69 

orders  for  patients,  88 
Spiced  jelly  cubes,  161 
Spinach  pudding,  146 

soup,  cream  of,  157 
Split  pea  soup,  112 
Sponge  cake,  198 

cherry,  181 

drops,  197 

Hamburg,  183 

Washington,  187 
Squab,  baked,  166 

broiled,  166 
Squash,  baked,  168 
Starch, 13 

Starchy  vegetables,  34 
Steak,  stuffed,  164 
Steamed  date  pudding,  182 
Steam  table,  97 
Stearin,  30 
Sterile  eggs,  57 
Sterilizing  milk,  23 
Stilton  cheese,  25 
Stimulants,  48 
Stomach  sweetbreads,  65 
Storage,  cold,  8,  54 

cold,  for  fruits,  45 

of  meats,  61 

temperature  for,  5 
Strawberry  Bavarian,  186 
Straws,  eggplant,  167 
Stuffed  apples,  169 

eggplant,  167 

eggs,  146 

peppers,  169, 174 

steak, 164 
Stuffing,  162 
Subacidity,  diet  for,  78 
Substitutes  for  butter,  27 
Suet,  30 
Sulphurous  acid,  46 


Summer  zephyr,  201 
Sundae,  cantaloupe,  180 
Sunshine  cake,  198 
Supplies,  buying,  at  Oak  Forest 

Infirmary,  107 
Surgical  patients,  feeding,  87 
Surprise  rice,  186 
Swedish  rolls,  190 
Sweetbreads,  65 

stomach,  65 

throat,  65 
Sweet  potatoes,  glazed,  168 

potato  sandwiches,  124 
Syllabub,  201 


Table,  steam,  97 

Tables  of  food  values,  Atwater, 

151 
Tannic  acid,  48 
Tannin,  48 

in  coffee,  49 
Tapioca,  40 
Tartaric  acid,  43 
Tartar  sauce,  175 
Tea,  48 

ball,  49 

beef,  65, 142 

punch,  201 
Teaching   dietetics,   practice   in, 
135 

dietetics,  theory  in,  133 
Temperature  for  storage,  5 
Terrapin,  mock,  160 
Test  breakfast,  76 

diet,  benzidin,  83 
Thein,  52 

Theobromin,  48,  51 
Theory  in  teaching  dietetics,  133 
Throat  sweetbreads,  65 
Thymus,  65 

gland,  65 
Toasted  marshmallows,  184 
Tolerance  for  carbohydrates,  72 

for  fats,  72 

for  proteins,  72 
Tomato  bouillon,  158 

eggs  in,  172 

jelly,  174 

jelly  salad,  143 

soup,  cream  of,  116, 158 


214 


Index. 


Tomatoes  stuffed  with  ripe 

olives,  168 
Tongues,  calves',  164 
Training,  diet,  for  nurses,  98 

school  work  in  dietetics,  131 
Treatment     for     gastric     ulcer, 
Sippey, 73 

in  diabetes,  Allen,  75 

individual,  72 
Trichinae,  64 
Tuberculosis  diet,  75 
Tuberculous,  feeding  the,  104 
Tuna  fish,  162 
Typhoid,  65,  74 

diet,  74 

diet  for  high-calorie,  79 

germs,  68 


U 


Ulcer,  diet  for  gastric,  76 

post-operative  care  of  duode- 
nal, 73 
post-operative  care  of  gastric, 

73 
Sippey  treatment  for  gastric, 
73 
Ulcers,  duodenal,  72 

gastric,  72 
Unit  system  in  buying,  7 
Unpolished  rice,  40 
Uses  of  butter,  27 


Valentine  sauce,  176 

Value,  food,  of  certain  products, 

12,19 
Values,  Atwater  tables  of  food, 

151 
in  calories,  food,  140 


Van  Noorden's  gruel,  143 
Veal,  63 

birds,  164 

broth, 64 

chops  en  casserole,  165 
Vegetable,  jellied,  168 

protein,  16 

salad,  174 

soup,  113 
Vegetables,  166 

combined  meats  and,  169 

green, 34 

in  the  dietary,  32 

starchy,  34 
Vitamines,  16 

W 

Wafers,  peanut,  200 
Washington  sponge,  187 
Water,  barley,  22,  39 

daily,  for  system,  18 

hard,  18 

lime,  22 

soft,  18 
Weight  equivalents,  140 
Welsh  rarebit,  26 
Wheat  flour,  whole,  38 
Whey,  22, 141 

Whims  of  private  patients,  89 
Whip,  prune,  185 
Whipped  cream  dessert,  187 
White  bread,  189 
Whole  wheat  flour,  38 
Wine  jelly,  144, 189 
Workers,  feeding  industrial,  110 


Zephyr,  summer,  201 


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